Radical retropubic prostatectomy and blood transfusion

OBJECTIVE: To determine whether there is a reduction in blood loss and blood transfusions associated with radical retropubic prostatectomy (RRP) by measuring the amount of blood loss and incidence of red blood cell (RBC) transfusions over time along with factors that may influence transfusions. PATIENTS AND METHODS: This is a retrospective study of patients who underwent RRP with and without the nerve-sparing dorsal venous complex (DVC) technique from 1985 to 1993 and in 1999. Transfusion rate, mean RBC loss, and preoperative and postoperative hemoglobin values were assessed. Univariate and multivariate regression analyses were performed. RESULTS: A total of 438 RRPs (276 DVC technique, 162 non-DVC technique) were reviewed and included in the study. The percentage of patients receiving allogeneic RBC transfusion decreased from 69% during 1985 to 1986 to 7.1% during 1999, and there was a decline in discharge hemoglobin values from 12.0 to 10.9 g/dL during this period. There was a significant reduction in mean hemoglobin concentration lost over time in the DVC technique group from 4.9 to 4.0 g/dL (P=.04) during the 1985 to 1990 study period, which persisted in 1999. CONCLUSION: Improvement in surgical technique and reduction in transfusion triggers resulted in large decreases of allogeneic RBC transfusions in patients undergoing RRP.