BACKGROUND: Radical retropubic prostatectomy is an intervention known to be associated with severe bleeding. Even experienced surgeons report a blood transfusion rate of up to 20%. The perioperative concept for this intervention underwent various modifications in January 2001. This study describes the effect of these modifications on the blood loss in a retrospective analysis comparing approximately 100 operations by a single experienced surgeon before the change (group 1) with 100 operations thereafter (group 2). MATERIALS AND METHODS: The new perioperative concept comprised the following points: reducing the intravenously applied volume, employing a peridural catheter (PDC), and maintaining a 25-30 degrees Trendelenburg's position. The difference in pre- and postsurgical hemoglobin (Hb) was analyzed before (group 1) and after the intervention (group 2). If transfusions were performed, this value was corrected according to the following formula: 1 ml of erythrocyte concentrate increases the patient's Hb by 0.003 g/dl. RESULTS: Assessment was possible in 201 of 234 cases, 110 from the first and 91 from the second group. The mean transfusion-corrected Hb difference was 5.3 g/dl in group 1 (20% transfusion rate) and 3.52 g/dl in group 2 (1.09% transfusion rate); p>0.0001. The median intravenous volume applied was 5.960 ml in group 1 and 3.490 ml in group 2 (p>0.0001). The complication rate did not differ between groups. CONCLUSION: The new perioperative concept minimizes the intraoperative blood loss during radical open retropubic prostatectomy. Transfusions are only necessary in rare cases. The complication rate remains unaltered.
BACKGROUND: Radical retropubic prostatectomy is an intervention known to be associated with severe bleeding. Even experienced surgeons report a blood transfusion rate of up to 20%. The perioperative concept for this intervention underwent various modifications in January 2001. This study describes the effect of these modifications on the blood loss in a retrospective analysis comparing approximately 100 operations by a single experienced surgeon before the change (group 1) with 100 operations thereafter (group 2). MATERIALS AND METHODS: The new perioperative concept comprised the following points: reducing the intravenously applied volume, employing a peridural catheter (PDC), and maintaining a 25-30 degrees Trendelenburg's position. The difference in pre- and postsurgical hemoglobin (Hb) was analyzed before (group 1) and after the intervention (group 2). If transfusions were performed, this value was corrected according to the following formula: 1 ml of erythrocyte concentrate increases the patient's Hb by 0.003 g/dl. RESULTS: Assessment was possible in 201 of 234 cases, 110 from the first and 91 from the second group. The mean transfusion-corrected Hb difference was 5.3 g/dl in group 1 (20% transfusion rate) and 3.52 g/dl in group 2 (1.09% transfusion rate); p>0.0001. The median intravenous volume applied was 5.960 ml in group 1 and 3.490 ml in group 2 (p>0.0001). The complication rate did not differ between groups. CONCLUSION: The new perioperative concept minimizes the intraoperative blood loss during radical open retropubic prostatectomy. Transfusions are only necessary in rare cases. The complication rate remains unaltered.
Authors: Philip W Friederich; Christiaan P Henny; Embert J Messelink; Mark G Geerdink; Tymen Keller; Karl-Heinz Kurth; Harry R Büller; Marcel Levi Journal: Lancet Date: 2003-01-18 Impact factor: 79.321
Authors: Volker Eichhorn; Alexander Maerz; Georg Salomon; Irmgard F Blanc; Daniel A Reuter; Alwin E Goetz Journal: World J Urol Date: 2011-11-26 Impact factor: 4.226