ABSTRACT
Objective
To describe contemporary management and outcomes of patients experiencing postoperative
hemorrhage after minimally invasive radical prostatectomy.
Materials and Methods
We retrospectively analyzed data from patients who underwent minimally invasive radical
prostatectomy at our institution between January 2010 and January 2017. Clinically
significant hemorrhage was defined as a decrease in hemoglobin of ≥30% or 4 g/dL from
preoperative to 4 or 14 hours postoperative measurement, receiving a blood transfusion
within 30 days, or undergoing a secondary procedure to control bleeding. Patients
were analyzed in 3 groups: (1) serially monitored only, (2) received a blood transfusion,
and (3) underwent a secondary procedure. Outcomes included imaging studies performed,
length of stay, emergency room visits, hospital readmissions, complication rates,
and functional outcomes.
Results
Of 3749 men, 4% (151/3749) had clinically significant hemorrhage, 1.6% (60/3749) received
a transfusion; 0.32% (12/3749) underwent a secondary procedure to control bleeding.
In a 30-day composite outcome, increased healthcare utilization (emergency room visit,
readmission, or Grade ≥3 complications), was seen in 25% of the serial monitoring
group, 65% of the transfusion group, and 100% in the secondary procedure group. This
rate in 3598 men without hemorrhage was 12.5%. One-year erectile function was poorest
in men who underwent a secondary procedure. Urinary functional outcomes were similar
in the 3 groups.
Conclusion
Most patients experiencing clinically significant hemorrhage will stabilize without
transfusion, and a very small fraction require secondary intervention. Patients experiencing
milder bleeding events utilized additional healthcare resources at approximately twice
the rate of those who did not, warranting appropriate counseling and postoperative
monitoring.
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Article info
Publication history
Published online: April 26, 2019
Accepted:
April 17,
2019
Received:
February 7,
2019
Footnotes
Funding/Financial Disclosure: This work was supported in part by funds from a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30-CA008748) to Memorial Sloan Kettering Cancer Center.
Declaration of Interest: No author has any conflicts of interest to declare.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
