Perioperative blood loss in open retropubic radical prostatectomy - Is it safe to get operated at an educational hospital?
BACKGROUND
Blood loss during radical prostatectomy has been a long term issue. The aim of this study was to investigate the influence of the training level of the first assistant regarding blood loss in open retropubic radical prostatectomy at an educational hospital.


METHODS
364 patients underwent radical prostatectomy from 11/2006 to 10/2007 at one institution operated by one surgeon. In 319 patients all predefined parameters were obtained. Training level was determined by year of residency (1-5 yrs) or consultant status. Perioperative blood loss was calculated using three parameters: Hemoglobin level before and after surgery, postoperative sucker volume and weight of compresses. Furthermore the influence of prostatic size and BMI was analyzed.


RESULTS
The Hb-decrease 24h postoperatively was 2.4 g/dl median (-0.4-7.6g/dl); sucker volume was 250 ml median (10-1500 ml); weight of compresses and swabs was 412 g median (0-972 g). One patient needed a transfusion with two erythrocyte concentrates one day after the surgery. There was no significant correlation regarding Hb-decrease (p = 0.86) or sucker volume plus weight of compresses (p=0.59) in regard to the years of residency of the assisting physician. Also the number of assisted operations (n <or= or > 20) had no significant influence on calculated blood loss (p = 0.38).


CONCLUSIONS
For an experienced surgeon the impact of the assistant regarding blood loss seems negligible. The training level of the assistant was not significantly correlated to a rise or decrease of perioperative blood loss. In our data radical prostatectomy could be safely performed at an educational hospital independent of the training level of the first assistant.
Karl
A
A
Department of Urology, University of Munich-Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. alexander.karl@med.uni-muenchen.de
Buchner
A
A
Becker
H
H
Staehler
M
M
Seitz
M
M
Stief
C
C
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards*; D006454:Hemoglobins / Q000378:metabolism; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
D006454:Hemoglobins