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Guido Torzilli, MD, PhD; Andrea Gambetti, MD; Daniele Del Fabbro, MD; Piera Leoni, MD; Natale Olivari, MD; Matteo Donadon, MD; Marco Montorsi, MD; Masatoshi Makuuchi, MD, PhD

Arch Surg. 2004;139:1061-1065.

Hypothesis  Transient postoperative anemia is partially a physiologic phenomenon, and variations in blood transfusion rates after liver resection in different series in part are due to different interpretations of postoperative anemia. Based on the hypothesis that transient postoperative anemia is partially a physiologic phenomenon, we analyzed serum hemoglobin and hematocrit values in patients who underwent liver resection without blood transfusion to check fluctuations.

Design  Prospective cohort study.

Setting  Community hospital.

Patients  Forty-six consecutive patients with primary and metastatic liver tumors.

Interventions  Surgical treatment consisting of dissection technique performed under intermittent warm ischemia, using intraoperative ultrasonography, and without blood transfusion.

Main Outcome Measures  Hematocrit and hemoglobin concentrations in serum sampled preoperatively and on the first, third, fifth, and seventh postoperative days.

Results  No postoperative mortality and major morbidity were observed. No patient received a blood transfusion. The hematocrit and hemoglobin concentrations in serum were significantly lower on the third postoperative day than on the first, fifth, and seventh postoperative days; differences among the first, fifth, and seventh postoperative days were not significant.

Conclusions  The fluctuations of hemoglobin and hematocrit levels after liver resection showed a steady and significant decrease until the third postoperative day and then an increase. Therefore, a decrease in the hemoglobin and hematocrit levels between first and fifth postoperative days without evidence of active bleeding from drain discharge or any other possible source of bleeding does not justify blood administration.

From the Hepatobiliary Surgery Unit, First Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy (Drs Torzilli, Gambetti, Del Fabbro, Leoni, and Olivari); Hepatobiliary Unit, University of Milano, Azienda Ospedaliera San Paolo, Milan, Italy (Drs Torzilli, Donadon, and Montorsi); and Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (Dr Makuuchi).

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Arch Surg 2008;143:1082-1090.
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