Background: Patients who require abdominal surgery but cannot receive blood products for religious reasons pose unique challenges. Our institution specializes in the medical and surgical care of these patients, specifically the judicious use of erythropoietin and intravenous iron, as well as limiting blood draws. Hemodilution is not used at our institution. We investigated to see how the outcomes in patients undergoing colectomy with bloodless care compared with those receiving traditional care. Methods: A total of 27 bloodless care patients underwent colectomy between 1998 and 2005. We reviewed the charts of these 27 patients along with 43 age matched, procedure-matched controls. Operations preformed included total abdominal colectomy, subtotal colectomy, open hemicolectomy, laparscopic assisted hemicolectomy and proctectomy. Demographics, comorbidities, laboratory tests and outcomes were then recorded and then examined with either a paired t-test or with chi-squared analysis. Results: There was no statistically significant difference in rates of coronary artery disease, hypertension, COPD, CVA, DM, end-stage renal disease, need for emergent surgery, or type of procedures between the two groups. The study group had a lower pre-op hemoglobin, 9.7 ± 2.8 g/dL vs. 11.8 ± 1.8 g/dL (p < .005 compared to control group), and nadir hemoglobin of 8.7 ± 2.4 g/dL vs 9.2 ± 1.8 g/dL (p < .01). The study group was more likely to have received erythropoeitin (85% vs. 9 %, p <.0001). There were no significant differences in age, prothombin time, blood loss during surgery, length of stay, or complication rates between the two groups (Table 1). There were no deaths (0/27)in the perioperative period (21 days from surgery) in the study group; there was one in the control group (1/43, 2%; p = NS). Conclusions: Bloodless care patients who have colorectal surgery have outcomes similar to patients who can accept blood products, despite lower hemoglobin levels and without the use of hemodilution. Our center found no differences in peri-operative mortality or morbidity.
Outcomes in study population and control population