Portal de Periódicos da CAPES

Patient blood management for liver resection: consensus statements using Delphi methodology

2018; Elsevier BV; Volume: 21; Issue: 4 Linguagem: Inglês

10.1016/j.hpb.2018.09.022

1477-2574

Julie Hallet, Shiva Jayaraman, Guillaume Martel, Jean‐François Ouellet, Yulia Lin, Stuart A. McCluskey, Kaitlyn Beyfuss, Paul J. Karanicolas, Kengo Asai, Jeffrey Barkun, K. Bertens, Prosanto Chaudhury, Sean P. Cleary, Michael Hogan, D. Jalink, Calvin Law, Scott Livingstone, I. McGilvray, Peter Metrakos, Mike Moser, Sulaiman Nanji, Jean‐François Ouellet, Pablo Serrano Balazote, John M. Shaw, Anton Skaro, Tsafrir Vanounou, Mark A. Walsh, Alice C. Wei, George Zogopoulos, Gareth Eeson, Simon Turcotte, Nikola Joly, Chris Wherett, Jordan Tarshis, Jeannie Callum, Susan Nahirniak,

Organ Transplantation Techniques and Outcomes

BackgroundBlood loss and transfusion remain a significant concern in liver resection (LR). Patient blood management (PBM) programs reduce use of transfusions and improve outcomes and costs, but are not standardized for LR. This study sought to create an expert consensus statement on PBM for LR using modified Delphi methodology.MethodsAn expert panel representing hepato-biliary surgery, anesthesiology, and transfusion medicine was invited to participate. 28 statements addressing the 3 pillars of PBM were created. Panelists were asked to rate statements on a 7-point Likert scale. Three-rounds of iterative rating and feedback were completed anonymously, followed by an in-person meeting. Consensus was reached with at least 70% agreement.ResultsThe 35 experts panel recommended routine pre-operative transfusion risk assessment, and investigation and management of anemia with iron supplementation. Intra-operatively, restrictive fluid administration without routine central line insertion was recommended, along with intermittent hepatic pedicle occlusion and surgical techniques considerations. Specific criteria for restrictive intra-operative and post-operative transfusion strategy were recommended.ConclusionsPBM for LR included medical and technical interventions throughout the perioperative continuum, addressing specificities of LR. Diffusion and adoption of these recommendations can standardize PBM for LR to improve patient outcomes and resource utilization.