New recommendations to reduce unnecessary blood tests after robot‐assisted radical prostatectomy

Nathan, Arjun; Hanna, Nancy; Rashid, Amir; Patel, Sonam; Phuah, Y; Flora, K; Fricker, Monty; Cleaveland, Paul; Kasivisvanathan, Veeru; Williams, Norman; Miah, Saiful; Collins, Justin; Kelkar, Anand; Sridhar, Ashwin; Hines, John; Briggs, T.; Kelly, John D.; Shah, Nimish; Shaw, Greg; Sooriakumaran, Prasanna; Rajan, Prabhakar; Lamb, Benjamin; Nathan, Senthil

doi:10.1111/bju.15511

Cited by 2 publications

(3 citation statements)

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“…Mostello et al examined the utility of routine postoperative sHgb measurements in patients undergoing primary total joint arthroplasty. 7 They found a transfusion rate of 0% in patients with a sHgb > 125 g/L preoperatively and > 100 g/L on POD 1. Eliminating subsequent measurements in these patients would have resulted in an overall reduction of 56% in sHgb measurements after POD 1 and significant savings.…”

confidence: 95%

“…By limiting investigations to at risk patients, Nathan et al demonstrated a reduction in routine postoperative bloodwork from 100% to 27% in patients undergoing robot assisted laparoscopic radical prostatectomy. 7 Benefits in their study included reduction in bloodwork related discharge delays from 6% to 0% with no missed postoperative complications during their study period.…”

confidence: 99%

“…The utility of routine bloodwork in the postoperative period has been questioned across a range of surgical specialties including urology. [5][6][7] Eliminating routine blood work in select patients has the potential to decrease health care costs, reduce patient anxiety and discomfort and limit unnecessary delays in discharge. The primary objective of this study was to examine pRBC transfusion rates and timing of these transfusions following RC to determine the clinical utility of routine serial postoperative sHgb measurements.…”

Section: Introductionmentioning

confidence: 99%

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Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Whalen¹,

Rendon

Bell³

et al. 2022

CUAJ

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Introduction: Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRBC) beyond postoperative day (POD) 2. Methods: We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRBC transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. Results: The median number of sHgb measurements per patient during admission was 9 (interquartile range [IQR] 7,25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb >100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRBC transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. Conclusions: Transfusion of PRBCs beyond POD2 was found to be common; however, patients with sHgb >100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge.

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confidence: 95%

confidence: 99%