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New perioperative management reduces bleeding in radical retropubic prostatectomy
Author(s) -
Schostak Martin,
Matischak Klaudia,
Müller Markus,
Schäfer Michel,
Schrader Mark,
Christoph Frank,
Miller Kurt
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05622.x
Subject(s) - medicine , trendelenburg position , radical retropubic prostatectomy , perioperative , complication , blood loss , surgery , prostatectomy , blood transfusion , urology , anesthesia , prostate , cancer
OBJECTIVE To describe the effect of modifications to radical retropubic prostatectomy (RRP, known to be associated with severe bleeding) on blood loss in a retrospective analysis comparing RRPs by one experienced surgeon before and after the changes. PATIENTS AND METHODS The new method comprised reducing the intravenously applied volume, using a peridural catheter and maintaining a 25–30° Trendelenburg position. The difference in haemoglobin before and after RRP was analysed before the changes (group 1) and after (group 2). If transfusions were required the haemoglobin value was corrected, whereby 1 mL of erythrocyte concentrate increased the patient's haemoglobin by 0.03 g/L. RESULTS Assessment was possible in 201 of 234 patients, 110 from group 1 and 91 from group 2. The mean transfusion‐corrected difference in haemoglobin was 53 g/L in group 1 (20% transfusion rate) and 35.2 g/L in group 2 (1.09% transfusion rate; P > 0.001). The median intravenous volume applied was 5.96 L in group 1 and 3.49 L in group 2 ( P < 0.001). The complication rate did not differ between the groups. CONCLUSION This new method minimizes the intraoperative blood loss during RRP; transfusions are only necessary in rare cases and the complication rate remained unaltered.