Open surgery is no longer the standard of care for treating minor kidney tumors; instead, minimally invasive techniques are increasingly being used. Open-era techniques are frequently followed, including blood typing and product orders before surgery. Researchers hope to quantify the existing practice of robot-assisted partial laparoscopic nephrectomy (RAPN) in an academic medical facility, including the frequency with which transfusions are required and the associated expenses. Patients who received RAPN and transfusions of blood products were identified by a retrospective evaluation of an institutional database. Differentiating factors for patients, tumors, and surgeries were established. About 9 (1%) of 804 patients who underwent RAPN between 2008 and 2021 needed a transfusion. Mean operative blood loss was significantly different between the transfused and nontransfused groups (527.8 ml vs. 162.5 ml, P<0.0001), as were the R.E.N.A.L. (for radius, exophytic/endophytic, nearness of tumor to collecting system, anterior/posterior, location relative to polar line) nephrometry score (7.1 vs. 5.9, P<0.05), hemoglobin Using logistic regression, they looked at the univariately linked factors with transfusion to see how well they predicted the outcome. The need for a transfusion was still linked to factors such as operative blood loss (P<0.05), nephrometry score (P=0.05), hemoglobin (P<0.05), and hematocrit (P<0.05). Blood typing and crossmatching at the hospital cost $1,320 per patient. As RAPN methods and results improve, so too should the level of preoperative testing that is performed on blood products to ensure they are safe for use in the operating room. Predictive indicators can be used to prioritize testing for individuals who are at a higher risk of complications.

 

Source: auajournals.org/doi/10.1097/UPJ.0000000000000331