The safety and efficacy of hypovolemic phlebotomy on blood loss and transfusion in liver surgery: a systematic review and meta-analysis

Faculty of Medicine, University of Ottawa, Canada. Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Canada. Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada. Library Services, The Ottawa Hospital, Canada. Hepatopancreatobiliary and Liver Transplantation Division, Centre hospitalier de l'Universite de Montreal, Canada. Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada. Electronic address: gumartel@ottawahospital.on.ca.

HPB : the official journal of the International Hepato Pancreato Biliary Association. 2019
Abstract
BACKGROUND Hypovolemic phlebotomy (HP) is a novel intervention that involves intraoperative removal of whole blood (7-10 mL/kg) without volume replacement. The subsequent central venous pressure (CVP) reduction is hypothesized to decrease blood loss and the need for blood transfusion. The objective was to conduct a systematic assessment of the safety and efficacy of HP on blood loss and transfusion in the liver surgery literature. METHODS MEDLINE, EMBASE, and Cochrane Library databases were searched. Outcomes of interest included blood loss, allogenic red blood cell transfusion, postoperative adverse events, and CVP change. A qualitative synthesis and meta-analysis were performed as appropriate. RESULTS Four cohort studies, one case series, and three randomized controlled trials involving 2255 patients were included. Meta-analysis of studies involving liver resections for any indication (n = 6) found no difference in transfusion (OR 0.38, p = 0.12) or incidence of adverse events with HP compared to non-use. Pooling of studies involving liver resections for an underlying pathology (n = 4) revealed HP was associated with significant reduction in transfusion (OR 0.25, p = 0.03) but no differences in blood loss (-173 mL, p = 0.17). CONCLUSION This review suggests HP is safe and associated with decreased transfusion in patients undergoing liver surgery. It supports further investigation.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine