Selecting patients for acute normovolemic hemodilution during hepatic resection: A prospective randomized evaluation of nomogram-based allocation Journal Article

  

Authors:	Frankel, T. L.; Fischer, M.; Grant, F.; Krone, J.; D'Angelica, M. I.; DeMatteo, R. P.; Jarnagin, W. R.; Gonen, M.
Article Title:	Selecting patients for acute normovolemic hemodilution during hepatic resection: A prospective randomized evaluation of nomogram-based allocation
Abstract:	Background: Acute normovolemic hemodilution (ANH) decreases transfusion rates but adds to the complexity of anesthetic management during hepatectomy. A randomized controlled trial was conducted to determine if selecting patients for ANH using a transfusion nomogram improves management and resource use compared with selection using extent of resection. Study Design: One hundred fourteen patients undergoing partial hepatectomy were randomized to a clinical arm (ANH used for resection of ≥3 liver segments) or a nomogram arm (ANH used for predicted probability of transfusion ≥50% based on a previously validated nomogram). The primary end point was appropriate management, defined as avoidance of ANH in patients at low risk or use of ANH in patients at high risk for allogeneic red blood cell transfusions. Results: Between September 2009 and May 2011, 58 patients were randomized to the clinical arm and 56 to the nomogram arm. Demographics, diagnoses, extent of resection, blood loss, and incidence and grade of complications did not differ between the 2 groups. There were no differences in perioperative transfusions or laboratory values. Nomogram-based allocation did not change appropriate management overall (80% vs 76% in the clinical arm; p = 0.65), but did result in comparable perioperative outcomes and a trend toward decreased ANH use (30% vs 47%; p = 0.09), particularly in low blood loss (estimated blood loss ≤400 mL) cases (12% vs 25%; p = 0.04). Conclusions: Although allocation of intraoperative management using a transfusion nomogram did not improve appropriate management overall, it more effectively identified low blood loss cases and reduced ANH use in patients least likely to benefit. © 2013 by the American College of Surgeons.
Keywords:	adult; cancer chemotherapy; controlled study; aged; middle aged; major clinical study; review; patient selection; postoperative care; antineoplastic agent; prospective study; intraoperative care; heart disease; randomized controlled trial; outcome assessment (health care); postoperative complication; hemodilution; nomograms; colon resection; hospital patient; liver resection; postoperative infection; hepatectomy; liver cancer; erythrocyte transfusion; nomogram; blood loss, surgical; predictive value; partial hepatectomy; decision support techniques; acute normovolemic hemodilution; postoperative thrombosis; metastatic colorectal cancer; fresh frozen plasma; ebl; estimated blood loss; international normalized ratio; anh; ffp; inr; packed red blood cell; pbrc; operative blood loss; bile duct reconstruction
Journal Title:	Journal of the American College of Surgeons
Volume:	217
Issue:	2
ISSN:	1072-7515
Publisher:	Elsevier Science, Inc.
Date Published:	2013-08-01
Start Page:	210
End Page:	220
Language:	English
DOI:	10.1016/j.jamcollsurg.2013.03.019
PROVIDER:	scopus
PUBMED:	23731968
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84880573947&partnerID=40&md5=27010ca244cacd1c0b8437f77b8e934c
Notes:	--- - "Export Date: 1 August 2013" - "CODEN: JACSE" - "Source: Scopus"

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