Multivariate analysis on radical retropubic prostatectomy associated blood loss: Importance of prostate size, pelvic lymph-node dissection and percentage of carcinoma

Background: Radical retropubic prostatectomy (RRP) has been associated with blood loss requiring blood transfusion. Aim: To define risk factors for blood transfusion. Study Design and Methods: The charts of 303 patients who underwent RRP between the years 1992 and 2002 were prospectively reviewed. Blood loss, blood requirements and correlative clinical data were recorded and a multivariate analysis model was applied. Results: Data was available in 293 cases (97%). A total of 122 patients were transfused (42%) with a median of 2 units of packed cells. Median estimated blood loss was 766 ml (range 150-2800). Blood loss declined progressively during the study period (1220 ml in 1992 to 826 ml in 2002). Multivariate analysis reveals that estimated blood loss and transfusion rate are related to performance of pelvic lymph node dissection, prostate size and percentage of cancer in the prostatectomy specimen. Conclusion: Our series indicates that blood preparation may be spared in patients who are not candidates for pelvic lymph node dissection with prostate smaller than 57 gr. and with less than 77% in the biopsy specimen (equivalent to <66% of cancer in the prostatectomy specimen).