title: Maximum surgical blood order schedule for pancreatoduodenectomy: a long way from uniform applicability!
abstract: BACKGROUND
  Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable life-saving resource and poses a significant financial burden on healthcare systems.
  
  
  OBJECTIVE
  To determine patient-specific factors associated with intra-operative transfusions, and if intra-operative blood transfusions impact postoperative morbidity.
  
  
  METHODS
  Analysis of consecutive patients undergoing pancreatoduodenectomy (PD) for pancreatic tumors.
  
  
  RESULTS
  A total of 384 patients underwent a classical PD with an estimated median blood loss of 200 cc and percentage transfused being 9.6%. Pre-existing hypertension, synchronous vascular resection, end-to-side pancreaticojejunostomy and nodal disease burden significantly associated with the need for intra-operative transfusions. Intra-operative blood transfusion not associated with postoperative morbidity.
  
  
  CONCLUSIONS
  Optimization of MSBOS protocols for PD is required for more judicious use of blood products.
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.|Hepatobiliary & Oesophagogastric Unit, Division of Surgery & Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia.|School of Medicine, Faculty of Medicine, Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Savio G
authors.initials: SG
authors.lastname: Barreto
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
authors.forename: Amanjeet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
authors.forename: Azhar
authors.initials: A
authors.lastname: Perwaiz
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Singh
authors.affiliation: Department of Clinical Research, Medanta, The Medicity, Gurgaon, India.
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Singh
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Chaudhary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000379:methods; D019468:Disease Management; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D055815:Young Adult
keywords: blood transfusion; clinical audit; morbidity; mortality; surgery