Contemporary management of hemorrhage after minimally invasive radical prostatectomy Journal Article

Authors: Dean, L. W.; Tin, A. L.; Chesnut, G. T.; Assel, M.; LaDuke, E.; Fromkin, J.; Vargas, H. A.; Ehdaie, B.; Coleman, J. A.; Touijer, K.; Eastham, J. A.; Laudone, V. P.
Article Title: Contemporary management of hemorrhage after minimally invasive radical prostatectomy
Abstract: 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. © 2019 Elsevier Inc.
Journal Title: Urology
Volume: 130
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2019-08-01
Start Page: 120
End Page: 125
Language: English
DOI: 10.1016/j.urology.2019.04.021
PUBMED: 31034916
PROVIDER: scopus
PMCID: PMC6660369
Notes: Source: Scopus
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MSK Authors
  1. Jonathan Coleman
    196 Coleman
  2. Vincent Laudone
    61 Laudone
  3. Abdelkrim Karim Touijer
    194 Touijer
  4. Behfar Ehdaie
    80 Ehdaie
  5. James Eastham
    435 Eastham
  6. Melissa Jean Assel
    43 Assel
  7. Amy Lam Ling Tin
    18 Tin
  8. Lucas Wyatt Dean
    3 Dean
  9. Emily Sehee Harris
    1 Harris