Use of preoperative autologous blood donation in patients undergoing radical retropubic prostatectomy

Objectives. To evaluate the appropriateness of autologous blood (AB) transf usion during radical retropubic prostatectomy in relation to the cardiopulm onary risk of the patient. Methods. We reviewed the medical records of 100 patients with American Soci ety of Anesthesiologists status I, II, or III who underwent radical retropu bic prostatectomy under general or combined general and epidural anesthesia . All patients had donated 2 units (U) of autologous blood, received 0, 1, or 2 U of autologous blood perioperatively, and received no allogeneic bloo d. Patients were placed in three cardiopulmonary risk groups on the basis o f risk factors or documented cardiopulmonary disease. The low-risk group wa s assigned a target discharge hematocrit of 24% or less; moderate-risk, 25% to 28%; and high-risk, 29% or greater. The appropriateness of transfusion was determined by whether patients' hematocrit was in their group's preassi gned range at discharge. Results. On the basis of discharge hematocrit, significantly more low-risk patients underwent inappropriate transfusion than moderate-risk (64% versus 26%, P = 0.006) or high-risk (64% versus 13%, P = 0.001) patients. Seventy -five AB units were discarded and at least 53 U were inappropriately transf used. We found an increase in the number of units of autologous blood trans fused when a larger estimated blood loss was reported (P < 0.001). The esti mated charge for the units discarded and inappropriately transfused exceede d $12,000. Conclusions. Sixty-four percent of autologous blood units were discarded or inappropriately transfused during radical retropubic prostatectomy. Transf usion of autologous blood was not governed by cardiopulmonary risk stratifi cation. If the decision to transfuse had been based on cardiopulmonary risk factors instead of estimated blood loss, fewer patients would have receive d autologous blood. UROLOGY 54: 130-134, 1999. (C) 1999, Elsevier Science I nc.