Comparison of transfusion requirements between open and robotic-assisted laparoscopic radical prostatectomy

Authors

  • Yakup Kordan,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Daniel A. Barocas,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Hernan O. Altamar,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Peter E. Clark,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Sam S. Chang,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Rodney Davis,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • S. Duke Herrell,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Roxy Baumgartner,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Vineet Mishra,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Robert C. Chan,

    1. Baylor College of Medicine, Department of Urology, Houston TX, USA
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  • Joseph A. Smith Jr,

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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  • Michael S. Cookson

    1. Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, Emory University School of Medicine, Department of Urology, Atlanta, GA and
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Daniel A. Barocas, Vanderbilt University Medical Center, Department of Urologic Surgery, A-1302 Medical Center North, Nashville, TN 37205, USA.
e-mail: dan.barocas@vanderbilt.edu

Abstract

Study Type – Therapy (individual cohort)
Level of Evidence 2b

OBJECTIVE

To determine whether robotic-assisted laparoscopic radical prostatectomy (RALP) is associated with a lower transfusion rate than radical retropubic prostatectomy (RRP).

PATIENTS AND METHODS

In this cohort study, we evaluated 1244 consecutive patients who underwent RALP (830) or RRP (414) between June 2003 and July 2006. Demographics, clinical characteristics, pathology, blood loss and transfusion data were collected prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocrit and transfusion using univariate statistics, and an exploratory multivariate model was developed.

RESULTS

RALP was associated with lower blood loss (median 100 vs 450 mL, P < 0.001) and a smaller change in haematocrit (median 7% vs 10%, P < 0.001) than RRP. Although both groups had low transfusion rates, the RALP group required fewer transfusions than the RRP group (0.8% vs 3.4%, P= 0.002). On univariate analysis, surgical approach (RRP vs RALP), estimated blood loss ≥500 mL and change in haematocrit ≥10% were the only the significant predictors of transfusion. In the exploratory multivariate model RALP was the only significant predictor of reduced need for transfusion, with an odds ratio of 0.23 (95% confidence interval 0.09–0.58; P= 0.002).

CONCLUSIONS

This study shows that RALP is associated not only with less blood loss and a smaller decrease in haematocrit, but also a decreased need for transfusion.

Ancillary