Acute Hemodilution is Safe in Patients with Comorbid Illness Undergoing Partial Hepatectomy

Abstract

Despite increased use of acute hemodilution (AH) to reduce perioperative blood transfusion in patients undergoing partial hepatectomy, there is a lack of data on safety in those with comorbid medical illness. We performed a retrospective review of 96 patients undergoing partial hepatectomy with AH and low central venous pressure (CVP) anesthesia. The cohort was compared with 63 patients undergoing partial hepatectomy using standard anesthetic management (SA) and low CVP anesthesia. All were American Society of Anesthesiologists physical status 3 or 4. 58 per cent were baseline hypertensive on medication. Hepatic resection was predominantly performed for metastatic colorectal (41%) and primary hepatic (32%) cancer. Forty per cent underwent major hepatectomy. The mean volume of blood removed for AH was 497 mL (range, 0 to 1 L). Most achieved low CVP (AH 90% vs SA 84%, P = 0.3). Blood loss was lower with AH (mean 480 mL vs 904 mL, P < 0.001). Blood transfusion rate was 74 per cent lower with AH ( P < 0.001). There was no difference in cardiac, respiratory, renal, or overall complications with AH compared with SA. Acute hemodilution is well tolerated by patients with comorbid illness undergoing partial hepatectomy, favoring ongoing use and further study.

The safety and efficacy of hypovolemic phlebotomy on blood loss and transfusion in liver surgery: a systematic review and meta-analysis

“…Thirty-nine articles were advanced to full text review, of which 8 met inclusion criteria. [11][12][13][21][22][23][24][25] Three studies were randomized control trials (RCT), 11,22,24 4 were retrospective cohort studies 12,21,23,25 and 1 was a case series. 13 Study characteristics are summarized in Table 1.…”

“…Included papers were published between 2006 and 2019 and involved 2255 patients, of which 57% underwent HP. [11][12][13][21][22][23][24][25] There were 1409 (63%) male participants with a weighted mean age of 55 years (6 studies). [11][12][13]21,23,24 One of the papers was published in Mandarin 22 while the remainder were in English.…”

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

“…–422 to 75) ml) and RBC transfusion (odds ratio 0·25, 95 per cent c.i. 0·07 to 0·87), and safe in comparison to standard care. Putchakayala and DiFronzo documented the largest decrease in EBL with HP (mean 480 versus 904 ml; P < 0·001) in a study reporting on safety and feasibility in patients with medical co‐morbidities.…”

“…0·07 to 0·87), and safe in comparison to standard care. Putchakayala and DiFronzo documented the largest decrease in EBL with HP (mean 480 versus 904 ml; P < 0·001) in a study reporting on safety and feasibility in patients with medical co‐morbidities. This represents a cohort distinct from that in the present study, which may account for the differences in findings.…”

“…Seven other studies reporting on the use of HP in liver surgery were identified in a systematic review, including two RCTs, four retrospective cohort studies of patients undergoing liver resection (3) or liver transplantation (1), and one case series of patients undergoing liver resection. Pooled analysis of studies reporting on patients undergoing HP versus standard of care at the time of liver resection for non‐transplant indications reported that HP was protective of blood loss (–173 (95 per cent c.i.…”