Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis
Abstract Background Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy. Methods In this systematic re...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02042-y |
| _version_ | 1797863750362988544 |
|---|---|
| author | Hui Ye Hanghang Wu Bin Li Pengfei Zuo Chaobo Chen |
| author_facet | Hui Ye Hanghang Wu Bin Li Pengfei Zuo Chaobo Chen |
| author_sort | Hui Ye |
| collection | DOAJ |
| description | Abstract Background Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy. Methods In this systematic review and meta-analysis, randomised controlled trials (RCTs) were searched in the Cochrane Library, Medline, Embase, and Web of Science to February 02, 2023. RCTs focused on cardiovascular interventions aimed at reducing blood loss or blood transfusion requirements during hepatectomy were included. The primary outcomes were perioperative blood loss amount, number of patients requiring allogeneic blood transfusion and overall occurrence of postoperative complications. The secondary outcomes were operating time, perioperative mortality rate, postoperative liver and kidney function and length of hospital stay. Results Seventeen RCTs were included in the analysis. A total of 841 patients who underwent hepatectomy in 10 trials were included in the comparative analysis between low central venous pressure (CVP) and control groups. The forest plots showed a low operative bleeding volume [(mean difference (MD): -409.75 mL, 95% confidence intervals (CI) -616.56 to -202.94, P < 0.001], reduced blood transfusion rate [risk ratio (RR): 0.47, 95% CI 0.34 to 0.65, P < 0.001], shortened operating time (MD: -13.42 min, 95% CI -22.59 to -4.26, P = 0.004), and fewer postoperative complications (RR: 0.76, 95% CI 0.58 to 0.99, P = 0.04) in the low CVP group than in the control group. Five and two trials compared the following interventions, respectively: ‘acute normovolaemic haemodilution (ANH) vs control’ and ‘autologous blood donation vs control’. ANH and autologous blood donation could not reduce the blood loss amount but greatly decreased the number of patients requiring allogeneic blood transfusion. No benefits were found in the rate of mortality and length of postoperative hospital stay in any of the comparisons. Conclusion Lowering the CVP seems to be effective and safe in adult patients undergoing hepatectomy. ANH and autologous blood donation should be used as a part of blood management for suitable patients in certain circumstances. Trial registration PROSPERO, CRD42022314061. |
| first_indexed | 2024-04-09T22:40:37Z |
| format | Article |
| id | doaj.art-852be0a9e7b74c6fbd7e57ed52dfdc37 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-09T22:40:37Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-852be0a9e7b74c6fbd7e57ed52dfdc372023-03-22T12:12:38ZengBMCBMC Anesthesiology1471-22532023-03-0123111610.1186/s12871-023-02042-yApplication of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysisHui Ye0Hanghang Wu1Bin Li2Pengfei Zuo3Chaobo Chen4Department of Anesthesiology, ZhongDa Hospital, Southeast UniversityDepartment of Immunology, Ophthalmology and ENT, School of Medicine, Complutense UniversityDepartment of Anesthesiology, ZhongDa Hospital, Southeast UniversityDepartment of Cardiology, ZhongDa Hospital, Southeast UniversityDepartment of General Surgery, Xishan People’s Hospital of Wuxi cityAbstract Background Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy. Methods In this systematic review and meta-analysis, randomised controlled trials (RCTs) were searched in the Cochrane Library, Medline, Embase, and Web of Science to February 02, 2023. RCTs focused on cardiovascular interventions aimed at reducing blood loss or blood transfusion requirements during hepatectomy were included. The primary outcomes were perioperative blood loss amount, number of patients requiring allogeneic blood transfusion and overall occurrence of postoperative complications. The secondary outcomes were operating time, perioperative mortality rate, postoperative liver and kidney function and length of hospital stay. Results Seventeen RCTs were included in the analysis. A total of 841 patients who underwent hepatectomy in 10 trials were included in the comparative analysis between low central venous pressure (CVP) and control groups. The forest plots showed a low operative bleeding volume [(mean difference (MD): -409.75 mL, 95% confidence intervals (CI) -616.56 to -202.94, P < 0.001], reduced blood transfusion rate [risk ratio (RR): 0.47, 95% CI 0.34 to 0.65, P < 0.001], shortened operating time (MD: -13.42 min, 95% CI -22.59 to -4.26, P = 0.004), and fewer postoperative complications (RR: 0.76, 95% CI 0.58 to 0.99, P = 0.04) in the low CVP group than in the control group. Five and two trials compared the following interventions, respectively: ‘acute normovolaemic haemodilution (ANH) vs control’ and ‘autologous blood donation vs control’. ANH and autologous blood donation could not reduce the blood loss amount but greatly decreased the number of patients requiring allogeneic blood transfusion. No benefits were found in the rate of mortality and length of postoperative hospital stay in any of the comparisons. Conclusion Lowering the CVP seems to be effective and safe in adult patients undergoing hepatectomy. ANH and autologous blood donation should be used as a part of blood management for suitable patients in certain circumstances. Trial registration PROSPERO, CRD42022314061.https://doi.org/10.1186/s12871-023-02042-yCardiovascular interventionsBlood lossTransfusionHepatectomyMeta-analysis |
| spellingShingle | Hui Ye Hanghang Wu Bin Li Pengfei Zuo Chaobo Chen Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis BMC Anesthesiology Cardiovascular interventions Blood loss Transfusion Hepatectomy Meta-analysis |
| title | Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis |
| title_full | Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis |
| title_fullStr | Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis |
| title_full_unstemmed | Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis |
| title_short | Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis |
| title_sort | application of cardiovascular interventions to decrease blood loss during hepatectomy a systematic review and meta analysis |
| topic | Cardiovascular interventions Blood loss Transfusion Hepatectomy Meta-analysis |
| url | https://doi.org/10.1186/s12871-023-02042-y |
| work_keys_str_mv | AT huiye applicationofcardiovascularinterventionstodecreasebloodlossduringhepatectomyasystematicreviewandmetaanalysis AT hanghangwu applicationofcardiovascularinterventionstodecreasebloodlossduringhepatectomyasystematicreviewandmetaanalysis AT binli applicationofcardiovascularinterventionstodecreasebloodlossduringhepatectomyasystematicreviewandmetaanalysis AT pengfeizuo applicationofcardiovascularinterventionstodecreasebloodlossduringhepatectomyasystematicreviewandmetaanalysis AT chaobochen applicationofcardiovascularinterventionstodecreasebloodlossduringhepatectomyasystematicreviewandmetaanalysis |