Pancreatic resections in patients who refuse blood transfusions. The application of a perioperative protocol for a true bloodless surgery

Autor: Tommaso Campagnaro, Fabio Bagante, R. Ziello, Filippo Nifosì, Domenico Girelli, Mario De Bellis, Andrea Ruzzenente, Calogero Iacono, Simone Conci, Alfredo Guglielmi
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Percutaneous
Blood management
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Splenectomy
Bloodless surgery
Blood Loss
Surgical
Bloodless Medical and Surgical Procedures
Perioperative Care
Pancreaticoduodenectomy
Treatment Refusal
03 medical and health sciences
Hemoglobins
0302 clinical medicine
Pancreatectomy
Postoperative Complications
medicine
Pancreas surgery
Humans
Blood Transfusion
Erythropoietin
Jehovah's Witnesses
Aged
Hepatology
business.industry
Transfusion
Gastroenterology
Perioperative
Length of Stay
Middle Aged
medicine.disease
Patient blood management protocol
Surgery
Pancreatic Neoplasms
Treatment Outcome
Pancreatic fistula
030220 oncology & carcinogenesis
Feasibility Studies
030211 gastroenterology & hepatology
Female
business
Complication
Carcinoma
Pancreatic Ductal
Zdroj: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]. 20(7)
ISSN: 1424-3911
Popis: Background The refusal of blood transfusions compels surgeons to face ethical and clinical issues. A single-institution experience with a dedicated perioperative blood management protocol was reviewed to assess feasibility and short-term outcomes of true bloodless pancreatic surgery. Methods The institutional database was reviewed to identify patients who refused transfusion and were scheduled for elective pancreatic surgery from 2010 through 2018. A protocol to optimize the hemoglobin values by administration of drugs stimulating erythropoiesis was systematically used. Results Perioperative outcomes of 32 Jehovah’s Witnesses patients were included. Median age was 67 years (range, 31–77). Nineteen (59.4%) patients were treated with preoperative erythropoietin. Twenty-four (75%) patients underwent pylorus-preserving pancreaticoduodenectomy, 4 (12.5%) distal pancreatectomy (DP) with splenectomy, 3 (9.4%) spleen-preserving DP, and 1 (3.1%) total pancreatectomy. Median estimated blood loss and surgical duration were 400 mL (range, 100–1000) and 470 min (range, 290–595), respectively. Median preoperative hemoglobin was 13.9 g/dL (range, 11.7–15.8) while median postoperative nadir hemoglobin was 10.5 g/dL (range, 7.1–14.1). The most common histological diagnosis (n = 15, 46.9%) was pancreatic ductal adenocarcinoma. Clavien-Dindo grade I-II complications occurred in fourteen (43.8%) patients while one (3.1%) patient had a Clavien-Dindo grade IIIa complication wich was an abdominal collection that required percutaneous drainage. Six (18.8%) patients presented biochemical leak or postoperative pancreatic fistula grade B. Median hospital stay was 16 days (range, 8–54) with no patient requiring transfusion or re-operation and no 90-day mortality. Conclusions A multidisciplinary approach and specific perioperative management allowed performing pancreatic resections in patients who refused transfusion with good short-term outcomes.
Databáze: OpenAIRE
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