Blood Transfusion Requirement but not Preoperative Anaemia is associated with Perioperative Complications following Robotic Assisted Radical Cystectomy with Intracorporeal Urinary Diversion
Author(s):
Mr Wei Shen Tan
,
Mr Wei Shen Tan
Affiliations:
Mr Benjamin Lamb
,
Mr Benjamin Lamb
Affiliations:
Dr Pramit Khetrapal
,
Dr Pramit Khetrapal
Affiliations:
Miss Mae-Yen Tan
,
Miss Mae-Yen Tan
Affiliations:
Dr Melanie Tan
,
Dr Melanie Tan
Affiliations:
Mr Ashwin Sridhar
,
Mr Ashwin Sridhar
Affiliations:
Dr Elizabeth Cervi
,
Dr Elizabeth Cervi
Affiliations:
Mr Simon Rodney
,
Mr Simon Rodney
Affiliations:
Mr Gerald Busuttil
,
Mr Gerald Busuttil
Affiliations:
Mr Senthil Nathan
,
Mr Senthil Nathan
Affiliations:
Mr John Hines
,
Mr John Hines
Affiliations:
Mr Greg Shaw
Mr Greg Shaw
Affiliations:
BAUS ePoster online library. Tan W. 06/26/17; 177333; P1-5 Disclosure(s): Research grant from the Urology Foundation and Masons Medical Research Trust
Dr. Wei Shen Tan
Dr. Wei Shen Tan
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Abstract
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Introduction
Preoperative anaemia is associated with adverse perioperative outcomes following open surgery. We assess the prevalence of preoperative anaemia and the impact of preoperative anaemia and blood transfusion requirement on 30- and 90-day complications in patients undergoing robotic assisted radical cystectomy with intracorporeal urinary diversion (iRARC).

Methods
166 consecutive patients were treated with iRARC. Prospective data was collected for patient demographics, clinical and pathological characteristics, perioperative variables, transfusion requirements and hospital length of stay. 90-day complications were classified according to Clavian-Dindo classification.

Results
The prevalence of preoperative anaemia was high (43.4%) and greatest in patients receiving neoadjuvant chemotherapy (48.6%) (p<0.001). Patients with preoperative anaemia were significantly more likely to have an Ileal conduit (p=0.033), higher cystectomy stage (≥pT3) (p=0.028) and a lower lymph node yield (p=0.031). However, preoperative anaemia was not associated with increased perioperative complications but was associated with blood transfusion requirement (p=0.001).

20.4% of patients received blood transfusion with intraoperative and postoperative blood transfusion rate was 10.2% and 13.9% respectively. 90-day all complication rate and 90-day major complication rate were 65.7% and 19.3% respectively. Intraoperative blood transfusion was not associated with increased morbidity however, postoperative blood transfusion requirement was independently associated with perioperative morbidity: all 90-day complications (p=0.009) and 90-day major complications (p=0.004).

Conclusion
The presence of preoperative anaemia in patients undergoing iRARC is not associated with increased surgical risk although preoperative anaemic patients were significantly more likely to require blood transfusion. Blood transfusion requirement and specifically postoperative blood transfusion is independently associated with perioperative morbidity.
Introduction
Preoperative anaemia is associated with adverse perioperative outcomes following open surgery. We assess the prevalence of preoperative anaemia and the impact of preoperative anaemia and blood transfusion requirement on 30- and 90-day complications in patients undergoing robotic assisted radical cystectomy with intracorporeal urinary diversion (iRARC).

Methods
166 consecutive patients were treated with iRARC. Prospective data was collected for patient demographics, clinical and pathological characteristics, perioperative variables, transfusion requirements and hospital length of stay. 90-day complications were classified according to Clavian-Dindo classification.

Results
The prevalence of preoperative anaemia was high (43.4%) and greatest in patients receiving neoadjuvant chemotherapy (48.6%) (p<0.001). Patients with preoperative anaemia were significantly more likely to have an Ileal conduit (p=0.033), higher cystectomy stage (≥pT3) (p=0.028) and a lower lymph node yield (p=0.031). However, preoperative anaemia was not associated with increased perioperative complications but was associated with blood transfusion requirement (p=0.001).

20.4% of patients received blood transfusion with intraoperative and postoperative blood transfusion rate was 10.2% and 13.9% respectively. 90-day all complication rate and 90-day major complication rate were 65.7% and 19.3% respectively. Intraoperative blood transfusion was not associated with increased morbidity however, postoperative blood transfusion requirement was independently associated with perioperative morbidity: all 90-day complications (p=0.009) and 90-day major complications (p=0.004).

Conclusion
The presence of preoperative anaemia in patients undergoing iRARC is not associated with increased surgical risk although preoperative anaemic patients were significantly more likely to require blood transfusion. Blood transfusion requirement and specifically postoperative blood transfusion is independently associated with perioperative morbidity.
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