Can bloodless surgery be applied to every patient undergoing major abdominal surgical intervention?

OBJECTIVE To evaluate the outcome of patients undergoing bloodless surgery compared with patients who did not refuse transfusions and to evaluate the possible extension of a relevant protocol to patients undergoing surgery to reduce the use of autologous blood transfusions. METHOD A retrospective study was performed with Jehovah's Witness patients undergoing major abdominal surgery between 2009 and 2013 at the Department of Surgical Sciences, "Sapienza" University of Rome, with no blood transfusions, compared with a homogeneous control group of patients undergoing similar major abdominal surgery performed by the same team in the same period. The type of surgery and the use of hemostatic agents for all the enrolled patients were recorded and analyzed. RESULTS The study group consisted of 55 Jehovah's Witness patients (33 males, 22 females; mean age 61.7 years, range 33-84 years) and 55 control patients (25 males, 30 females; mean age 74.1 years, range 48-90 years). There was no intraoperative or postoperative bleeding, and no cardiorespiratory complications were observed during or after surgery among the patients in the study group. This study showed that bloodless surgery is not associated with a greater number of complications. The postoperative recovery was comparable to that of transfused patients undergoing standard surgical procedures. CONCLUSIONS The present study demonstrates that bloodless surgery is feasible and safe when conducted according to a specific protocol by an experienced and dedicated multidisciplinary team. It is suggested that the protocol followed for bloodless surgery be further evaluated in prospective studies, involving traditional surgery in order to evaluate the benefits of minimization of blood loss