Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Introduction: Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRBC) beyond postoperative day (POD) 2. Methods: We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRBC transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. Results: The median number of sHgb measurements per patient during admission was 9 (interquartile range [IQR] 7,25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb >100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRBC transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. Conclusions: Transfusion of PRBCs beyond POD2 was found to be common; however, patients with sHgb >100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge.