South Central Section of the AUA 2022

SCS AUA 2022: Safe Or Superfluous? Routine Preoperative Blood Product Testing In The Robotic Partial Nephrectomy Era

( The surgical treatment of small renal masses has shifted from open to minimally invasive approaches following the proliferation of the surgical robot in urologic practice. Reduced blood loss is an advantage of robotic-assisted surgery, but preoperative blood typing and product orders often mirror the practices of the open era. Testing for blood type and crossmatch involves significant cost. The aim of this study was to define the rate of transfusion after robotic partial nephrectomy at an academic medical center and the costs associated with current practice.

The authors performed a retrospective review of an institutional database was utilized to identify patients who underwent robotic partial nephrectomy and transfusion of blood products using Current Procedural Terminology (CPT) codes. Patients were included if the transfusion was required during the initial surgical admission or readmission for surgical complications. Patient, tumor, and operative variables were identified and recorded through retrospective chart review. 

From 2008 to 2021, 804 patients underwent robotic partial nephrectomy. Nine (1.1%) required

transfusions related to their partial nephrectomy procedure. Of those nine patients, two (22.2%) required intraoperative transfusions, with only one due to high-volume blood loss. Comparison of categorical data between the transfusions and non-transfusion groups revealed no significant difference in age, body mass, Charlson Comorbidity Index, tumor size, or warm ischemia time. The transfused group had lower preoperative hemoglobin and hematocrit levels and higher intraoperative blood loss (P < 0.05). Tumor complexity was higher in transfused group (P < 0.05). A logistic regression model was used to identify preoperative variables that can be used to identify an increased transfusion risk. Analysis indicated that preoperative hemoglobin and hematocrit (P < 0.05) and RENAL nephrometry score (P = 0.05) were predictive for perioperative transfusion. The hospital charge for blood typing and crossmatching was $1320 USD. The approximate testing cost for all patients who did not require blood products was $1,049,400 USD.

In summary, blood transfusion was a rare (and costly) event in patients undergoing robotic partial nephrectomy. With the maturity of robotic partial nephrectomy techniques and outcomes, the extent of preoperative testing related to blood products should evolve to better reflect current procedural risks while balancing cost in an increasingly resource-constrained healthcare environment. Utilization of a type and screen rather than crossmatching in selected low complexity cases may offer significant cost savings and promotes resource stewardship without detriment to the patient.

Presented by: Atiyeh Samadi, MS, University of Kansas School of Medicine, University of Kansas Medical Center

Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA