Patient, surgeon, and treatment characteristics associated with homologous blood transfusion requirement during radical retropubic prostatectomy: multivariate nomogram to assist patient counseling.
OBJECTIVE
To identify the preoperative patient, treatment, and surgeon factors associated with the administration of homologous blood transfusion during or after radical retropubic prostatectomy (RRP) to be able to better inform patients regarding the probability of transfusion. Homologous blood transfusion is sometimes required during or after RRP, but predictive models for estimating transfusion probability using patient and surgical characteristics are lacking.


METHODS
Data were prospectively collected regarding patient characteristics, cancer severity, surgeon experience, anesthetic used, operative blood loss, and transfusion among 1123 consecutive RRP cases. Multivariate regression analysis identified baseline factors associated with a homologous transfusion requirement and generated a model for predicting the likelihood of perioperative homologous transfusion.


RESULTS
Homologous transfusion was administered in 3.8% of subjects; the mean estimated blood loss was 953 mL. Multivariable regression analysis identified prostate size (P <0.0001, odds ratio [OR] 1.74), use of general anesthesia (P = 0.01, OR 2.22), use of neoadjuvant hormonal therapy (P = 0.006, OR 3.35), and surgeon expertise (P <0.0001, OR 8.63) as independent risk factors associated with a need for perioperative homologous transfusion. The most influential factor, surgical expertise, clustered among surgeons who performed more than 15 RRPs annually, because these surgeons had lower transfusion rates and lower estimated blood loss more consistently than did surgeons who performed fewer RRPs annually.


CONCLUSIONS
Larger prostate size, use of general anesthesia, use of neoadjuvant hormonal therapy, and annual surgeon case volume were independently associated with an increased probability that an individual patient would receive homologous transfusion during or after RRP. A nomogram indicating the probability of homologous transfusion based on these factors provides a benchmark of expected homologous transfusion rates according to individual patient and treatment parameters.
Dash
Atreya
A
Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Dunn
Rodney L
RL
Resh
Jennifer
J
Wei
John T
JT
Montie
James E
JE
Sanda
Martin G
MG
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D000758:Anesthesia / Q000379:methods / Q000706:statistics & numerical data; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D020360:Neoadjuvant Therapy; D049451:Nomograms; D009929:Organ Size; D010361:Patients / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011336:Probability; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012307:Risk Factors
D018931:Antineoplastic Agents, Hormonal