Clinical Utiliy of Routine Postoperative Laboratory Tests After Laparoscopic Prostate Surgery

Abstract

Background: Post-operative protocols, including blood tests, are frequently implemented to standardize care and as guarantees of safety before discharge. They might however be unnecessary after minimally invasive surgery. Our objective was to determine the clinical utility of routine postoperative blood test after laparoscopic prostate surgery.

Methods: A retrospective review of 231 patients who underwent laparoscopic prostatectomy was conducted. The primary outcome was the rate of clinically significant blood loss, defined as a drop in hemoglobin level of 4 g/dL or the need for a blood transfusion. A logistic regression model was developed for the outcomes of interest.

Results: Final review included 231 patients. Forty-five patients (19.5%) had at least one abnormal blood test parameter on the first post-operative day. Eleven patients (4.8%) had clinically significant blood loss, with four patients (1.7%) overall requiring a blood transfusion. All patients requiring a transfusion had a significant complication that was clinically evident; all other abnormal blood tests were mild and did not change routine care. Signs of hemodynamic instability were the main predictors of clinically significant blood loss on multivariable regression analysis, with an odds ratio (OR) of 4.14 (95% confidence interval (CI): 1.12 - 15.35; P = 0.034).

Conclusions: Routine post-operative blood tests have low yield, seldomly changing care. Signs of hemodynamic instability were the main predictors of significant blood loss and can be used as triggers for laboratory testing. Reducing routine laboratory tests improves patients' experience, diminishes cost and hospital stay. Our results provide evidence to perform radical prostatectomies in a 1-day surgery setting.

World J Nephrol Urol. 2024;13(1):13-18
doi: https://doi.org/10.14740/wjnu444