Eight-year experience of bloodless surgery at a tertiary care hospital in Korea.

BACKGROUND

The Soonchunhyang University Hospital Bloodless Center was established in 2000, and more than 2000 bloodless surgeries has been performed there since. This study was carried out to analyze the characteristics of patients who underwent bloodless surgery and the influences of postoperative lowest hemoglobin level (H(blow)) along with the lowest postoperative Hb/preoperative Hb ratio (H(blow/pre)) on successful completion of bloodless surgery.

STUDY DESIGN AND METHODS

A total of 1407 patients were included. Patients were divided according to H(blow) into not more than 7 and more than 7 g/dL groups and compared regarding use of transfusion alternatives, coexisting risk factors, and mortality rate. They were also grouped as H(blow/pre) of not more than 0.5 or more than 0.5, and mortalities were compared between them.

RESULTS

Jehovah's Witnesses comprised 1323 (94.0%) of the total population. The frequency of simultaneous use of erythropoietin and iron was significantly higher in H(blow) of not more than 7 group than in more than 7 g/dL group, as was the use of hemostatics. Among risk factors urging transfusion, the frequencies of cardiovascular disease and cerebrovascular accident were higher in H(blow) of not more than 7 than in the more than 7 g/dL group. Mortality rates in H(blow) of not more than 7 g/dL and H(blow/pre) of not more than 0.5 groups were significantly higher than those in H(blow) of more than 7 g/dL and H(blow/pre) of more than 0.5 groups, respectively.

CONCLUSION

We have provided an effective bloodless surgery program for the past 10 years. A prospective multicenter study with other bloodless centers in Korea concerning mortality rates, actual operative blood loss, and postoperative complications in high-risk group of patients would be needed to establish evidence-based guidelines for bloodless surgery.