Contemporary Management of Hemorrhage After Minimally Invasive Radical Prostatectomy.

Autor: Dean LW; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Tin AL; Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., Chesnut GT; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: chesnutg@mskcc.org., Assel M; Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., LaDuke E; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Fromkin J; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Vargas HA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY., Ehdaie B; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Coleman JA; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Touijer K; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Eastham JA; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Laudone VP; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Jazyk: angličtina
Zdroj: Urology [Urology] 2019 Aug; Vol. 130, pp. 120-125. Date of Electronic Publication: 2019 Apr 26.
DOI: 10.1016/j.urology.2019.04.021
Abstrakt: Objective: To describe contemporary management and outcomes of patients experiencing postoperative hemorrhage after minimally invasive radical prostatectomy.
Materials and Methods: We retrospectively analyzed data from patients who underwent minimally invasive radical prostatectomy at our institution between January 2010 and January 2017. Clinically significant hemorrhage was defined as a decrease in hemoglobin of ≥30% or 4 g/dL from preoperative to 4 or 14 hours postoperative measurement, receiving a blood transfusion within 30 days, or undergoing a secondary procedure to control bleeding. Patients were analyzed in 3 groups: (1) serially monitored only, (2) received a blood transfusion, and (3) underwent a secondary procedure. Outcomes included imaging studies performed, length of stay, emergency room visits, hospital readmissions, complication rates, and functional outcomes.
Results: Of 3749 men, 4% (151/3749) had clinically significant hemorrhage, 1.6% (60/3749) received a transfusion; 0.32% (12/3749) underwent a secondary procedure to control bleeding. In a 30-day composite outcome, increased healthcare utilization (emergency room visit, readmission, or Grade ≥3 complications), was seen in 25% of the serial monitoring group, 65% of the transfusion group, and 100% in the secondary procedure group. This rate in 3598 men without hemorrhage was 12.5%. One-year erectile function was poorest in men who underwent a secondary procedure. Urinary functional outcomes were similar in the 3 groups.
Conclusion: Most patients experiencing clinically significant hemorrhage will stabilize without transfusion, and a very small fraction require secondary intervention. Patients experiencing milder bleeding events utilized additional healthcare resources at approximately twice the rate of those who did not, warranting appropriate counseling and postoperative monitoring.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: