Blood transfusion and hemostatic agents used during radical cystectomy

  • Nahid Punjani 1University of Ottawa Medical School, University of Ottawa, Ottawa, Ontario, Canada
  • Luke T. Lavallée Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  • Franco Momoli Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Dean Fergusson Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Kelsey Witiuk Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Ranjeeta Mallick Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Christopher Morash Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  • Ilias Cagiannos Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  • Rodney H. Breau Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Keywords: Blood Transfusion, Cystectomy, Hemorrhage

Abstract

Background: Radical cystectomy may result in significant blood loss necessitating transfusion. The purpose of this study was to determine what intra-operative techniques and hemostatic agents are currently used by uro-oncologists to prevent and control blood loss during radical cystectomy.

Methods: In August 2011, members of the Society of Urologic Oncology (SUO) were solicited to complete an online survey. Residents, fellows and non-urologists were excluded. Canadian members received a personal email invitation. Respondents were asked to provide demographic information and opinions regarding blood loss and transfusion. Participants were also asked to report techniques used to reduce blood loss.

Results: Of the 34 Canadian SUO members with registered email addresses, 27 (79%) completed the survey and met inclusion criteria as staff urologists who perform radical cystectomy. In addition, 52 non-Canadian SUO members were included in the analysis. Among all SUO respondents, a high proportion (73; 88%) reported using topical hemostatic agents during cystectomy. Thirty-six (46%) surgeons reported occasionally using procedural techniques and 9 (11%) using systemic hemostatic agents. Number of years since training was associated with decreased use of topical agents and increased use of procedural techniques (p < 0.01). Number of cystectomies per year was associated with decreased use of topical hemostatic agents (p < 0.01).

Interpretation: Based on a survey of practice, there is significant risk of blood loss requiring transfusion during radical cystectomy. Surgeons frequently use topical hemostatic agents and rarely use systemic drugs to prevent or control blood loss. Trials evaluating agents and techniques to reduce blood loss during radical cystectomy are needed.

Published
2013-05-13
How to Cite
Punjani, N., Lavallée, L. T., Momoli, F., Fergusson, D., Witiuk, K., Mallick, R., Morash, C., Cagiannos, I., & Breau, R. H. (2013). Blood transfusion and hemostatic agents used during radical cystectomy. Canadian Urological Association Journal, 7(5-6), e275-80. https://doi.org/10.5489/cuaj.1002
Section
Original Research