TY - JOUR
T1 - Patient blood management for liver resection
T2 - consensus statements using Delphi methodology
AU - for the Canadian Hepato-Pancreatico-Biliary Association group
AU - Hallet, Julie
AU - Jayaraman, Shiva
AU - Martel, Guillaume
AU - Ouellet, Jean François B.
AU - Lin, Yulia
AU - McCluskey, Stuart
AU - Beyfuss, Kaitlyn A.
AU - Karanicolas, Paul J.
AU - Asai, Kengo
AU - Barkun, Jeffrey
AU - Bertens, Kimberley
AU - Chaudhury, Prosanto
AU - Cleary, Sean
AU - Hogan, Michael
AU - Jalink, Diderick
AU - Law, Calvin
AU - Livingstone, Scott
AU - McGilvray, Ian
AU - Metrakos, Peter
AU - Moser, Mike
AU - Nanji, Sulaiman
AU - Ouellet, Jean François
AU - Serrano, Pablo
AU - Shaw, John
AU - Skaro, Anton
AU - Vanounou, Tsafrir
AU - Walsh, Mark
AU - Wei, Alice
AU - Zogopoulos, George
AU - Eeson, Gareth
AU - Turcotte, Simon
AU - Joly, Nikola
AU - Wherett, Chris
AU - Tarshis, Jordan
AU - Callum, Jeannie
AU - Nahirniak, Susan
N1 - Funding Information:
We would like to thank the members of the expert panel listed in Table 1 for their active participation in the Delphi surveys. We would also like to acknowledge Dr. Frances Wright for her methodology support in building this expert consensus statement. This study was funded by an unrestricted research grant from the Baxter Corportation.
Publisher Copyright:
© 2018 International Hepato-Pancreato-Biliary Association Inc.
PY - 2019/4
Y1 - 2019/4
N2 - Background: Blood 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. Methods: An 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. Results: The 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. Conclusions: PBM 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.
AB - Background: Blood 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. Methods: An 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. Results: The 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. Conclusions: PBM 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.
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U2 - 10.1016/j.hpb.2018.09.022
DO - 10.1016/j.hpb.2018.09.022
M3 - Article
C2 - 30446290
AN - SCOPUS:85056393505
SN - 1365-182X
VL - 21
SP - 393
EP - 404
JO - HPB
JF - HPB
IS - 4
ER -