Examining the utility of routine perioperative hemoglobin monitoring in patients undergoing radical nephrectomy.

IF 1.9 4区 医学 Q3 UROLOGY & NEPHROLOGY
Charlie J Gillis, Ali Sherazi, Ricardo A Rendon, Gabriela Ilie, Ross Mason
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引用次数: 0

Abstract

Introduction: Patients undergoing radical nephrectomy (RN) are often admitted with protocolized bloodwork for several days following their operation, yet the clinical value of serial hemoglobin (Hgb) measurements has not been established. This can lead to unnecessary costs and can prolong patient stay, despite the absence of an intervention based on these lab values. This study sought to examine perioperative Hgb values and identify those patients at high risk of bleeding requiring intervention, as well as those patients who are unlikely to require further monitoring.

Methods: Patient and perioperative factors were retrospectively examined for a cohort of 259 radical nephrectomy patients from 2015-2021 in Atlantic Canada. Postoperative Hgb values and transfusion rates were recorded. A multivariate logistic regression analysis was performed to identify variables associated with requiring a blood transfusion.

Results: Overall, 31 (12%) patients required a blood transfusion in the postoperative period. Median estimated blood loss (EBL) was 150 (interquartile range [IQR] 100-300) ml, with a median Hgb change of 15 (IQR 9-22) g/L from preoperative to postoperative day 1 (POD1). In patients with a Hgb loss of ≤15 g/L (n=131), transfusion was only required in four patients (3.1%). Among those with a POD1 Hgb >100 g/L (n=199), only four (2%) required transfusion. These patients were identified as having complications based on hemodynamic instability. On multivariate regression analysis, factors found to be associated with higher transfusion risk were age and intraoperative EBL, while higher preoperative Hgb was found to be associated with a lower transfusion risk.

Conclusions: In patients who have a reassuring POD1 Hgb value, with a drop of <15 g/L or an absolute value of >100 g/L, consideration can be made towards discontinuing routine Hgb testing in the absence of a clinical indication. Age, blood loss, and preoperative Hgb are factors that may affect a patient's overall risk of transfusion.

探讨对接受根治性肾切除术的患者进行常规围手术期血红蛋白监测的实用性。
简介:接受根治性肾切除术(RN)的患者通常会在术后数天内接受规范的血液检查,但连续血红蛋白(Hgb)测量的临床价值尚未确定。这可能会导致不必要的费用并延长患者的住院时间,尽管没有根据这些实验室值进行干预。本研究旨在检查围手术期的血红蛋白值,并确定哪些患者出血风险高,需要进行干预,哪些患者不太可能需要进一步监测:对加拿大大西洋地区 2015-2021 年间 259 例根治性肾切除术患者进行了患者和围手术期因素回顾性研究。记录了术后血红蛋白值和输血率。进行了多变量逻辑回归分析,以确定与需要输血相关的变量:总体而言,31 名(12%)患者在术后需要输血。估计失血量(EBL)中位数为 150 毫升(四分位数间距 [IQR] 100-300),从术前到术后第 1 天(POD1)的血红蛋白变化中位数为 15 克/升(IQR 9-22 克/升)。在血红蛋白下降≤15 克/升的患者(131 人)中,只有 4 人(3.1%)需要输血。在 POD1 血红蛋白大于 100 克/升的患者(人数=199)中,只有 4 人(2%)需要输血。根据血流动力学不稳定性确定这些患者出现了并发症。通过多变量回归分析发现,与较高输血风险相关的因素是年龄和术中 EBL,而较高的术前血红蛋白与较低的输血风险相关:结论:对于 POD1 血红蛋白值低于 100 g/L 的患者,如果没有临床指征,可以考虑停止常规血红蛋白检测。年龄、失血量和术前血红蛋白都是可能影响患者整体输血风险的因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cuaj-Canadian Urological Association Journal
Cuaj-Canadian Urological Association Journal 医学-泌尿学与肾脏学
CiteScore
2.80
自引率
10.50%
发文量
167
审稿时长
>12 weeks
期刊介绍: CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.
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