Authors Charlie J. Gillis Department of Urology, Dalhousie University, Halifax NS Ali Sherazi Dalhousie University School of Medicine, Saint John NB Ricardo A. Rendon Department of Urology, Dalhousie University, Halifax NS Gabriela Ilie Department of Community Health and Epidemiology, Dalhousie University, Halifax NS Ross Mason Department of Urology, Dalhousie University, Halifax NS DOI: https://doi.org/10.5489/cuaj.8603 Keywords: Perioperative Outcomes, Clinical Outcomes, Complications, Kidney Cancer, Nephrectomy, Perioperative complications Abstract

INTRODUCTION: Patients undergoing radical nephrectomy (RN) are often admitted with protocolized bloodwork for several days following their operation, yet the clinical value of serial hemoglobin (Hgb) measurements has not been established. This can lead to unnecessary costs and can prolong patient stay, despite the absence of an intervention based on these lab values. This study sought to examine perioperative Hgb values and identify those patients at high risk of bleeding requiring intervention, as well as those patients who are unlikely to require further monitoring.

METHODS: Patient and perioperative factors were retrospectively examined for a cohort of 259 radical nephrectomy patients from 2015–2021 in Atlantic Canada. Postoperative Hgb values and transfusion rates were recorded. A multivariate logistic regression analysis was performed to identify variables associated with requiring a blood transfusion.

RESULTS: Overall, 31 (12%) patients required a blood transfusion in the postoperative period. Median estimated blood loss (EBL) was 150 (interquartile range [IQR] 100–300) ml, with a median Hgb change of 15 (IQR 9–22) g/L from preoperative to postoperative day 1 (POD1). In patients with a Hgb loss of ≤15 g/L (n=131), transfusion was only required in four patients (3.1%). Among those with a POD1 Hgb >100 g/L (n=199), only four (2%) required transfusion. These patients were identified as having complications based on hemodynamic instability. On multivariate regression analysis, factors found to be associated with higher transfusion risk were age and intraoperative EBL, while higher preoperative Hgb was found to be associated with a lower transfusion risk.

CONCLUSIONS: In patients who have a reassuring POD1 Hgb value, with a drop of <15 g/L or an absolute value of >100 g/L, consideration can be made towards discontinuing routine Hgb testing in the absence of a clinical indication. Age, blood loss, and preoperative Hgb are factors that may affect a patient’s overall risk of transfusion.

Downloads

Download data is not yet available.

How to Cite

Gillis, C. J., Sherazi, A., Rendon, R. A., Ilie, G., & Mason, R. (2024). Examining the utility of routine perioperative hemoglobin monitoring in patients undergoing radical nephrectomy. Canadian Urological Association Journal, 18(6), 185–9. https://doi.org/10.5489/cuaj.8603

Issue Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

Post the Article on any Web site Translate or authorize a translation of the Article Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party; That all individuals who have made a substantive contribution to the article are acknowledged; That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and That the Article does not libel or violate the privacy rights of any third party.