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Central Venous Pressure Drop After Hypovolemic Phlebotomy is a Strong Independent Predictor of Intraoperative Blood Loss During Liver Resection

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function.

Methods

A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23–89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss.

Results

The median CVP before blood salvage was 8 mmHg (range 4–30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200–1000 ml). After HP, CVP decreased to a median of 3 mmHg (range –2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2–14 mmHg). The median EBL during liver resection was 165 ml (range 0–800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5–1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44–1.68 g/dl). The CVP drop was associated with EBL (P < 0.001). There was no significant impact of CVP drop on postoperative Scr.

Conclusion

A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.

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DISCLOSURE

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium

    Andries Ryckx MD, Mathias Clarysse MD, Franky Vansteenkiste MD & Mathieu D’Hondt MD

  2. Department of Nephrology, Groeninge Hospital, Kortrijk, Belgium

    Claudine Christiaens MD

  3. Department of Anesthesiology, Groeninge Hospital, Kortrijk, Belgium

    Pieter Jan Steelant MD

  4. Department of Abdominal and Hepatobiliary Surgery, Jessa Hospital, Hasselt, Belgium

    Gregory Sergeant MD, PhD

  5. Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium

    Isabelle Parmentier

  6. Interdisciplinary Research Center, Leuven University Campus, Kortrijk, Belgium

    Hans Pottel PhD

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  1. Andries Ryckx MD
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Correspondence to Mathieu D’Hondt MD.

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Ryckx, A., Christiaens, C., Clarysse, M. et al. Central Venous Pressure Drop After Hypovolemic Phlebotomy is a Strong Independent Predictor of Intraoperative Blood Loss During Liver Resection. Ann Surg Oncol 24, 1367–1375 (2017). https://doi.org/10.1245/s10434-016-5737-7

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  • DOI: https://doi.org/10.1245/s10434-016-5737-7

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