ACUTE PREOPERATIVE HEMODILUTION IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY - A CASE-STUDY ANALYSIS OF EFFICACY

Despite published guideline and consensus conference recommendations, the role of acute preoperative hemodilution in elective surgery has no t been defined. We performed a case study analysis of this technique i n a large surgical program in order to estimate its degree of efficacy as practiced routinely, and to better define its role as a blood cons ervation strategy. Patients undergoing elective radical prostatectomy by one surgeon during a 3-yr period were analyzed retrospectively for blood loss, hematocrit levels, records of acute hemodilution, and tran sfusion outcomes. Patient blood volumes were determined by nomogram; f inal hematocrits after discrete blood volumes lost by surgery or by he modilution were estimated. Sixteen (4.4%) of 410 total patients review ed underwent hemodilution, representing 0 (0%), 4 (3%), and 12 (8%) of the 112, 146, and 152 patients undergoing surgery in years 1, 2, and 3, respectively. Median whole blood volume and mean red blood cell (RB C) volume removed by hemodilution was 1000 mL (range, 400-1500 mL) and 338 mL (range, 156-585 mL), respectively, representing 15% of patient s' admission RBC volume. Net intraoperative RBC volume ''saved'' in lo sses by this technique was 95 mL (range, 25-204 mL), representing only 9.3% (range, 4%-17%) of total RBC volume lost during hospitalization. RBC volume removed by hemodilution constituted 34% (95-283 mL) of the total RBC volume transfused. We conclude that use of acute preoperati ve hemodilution remains in evolution and, as a single blood conservati on intervention, contributes only modestly to blood conservation.