Objectives This study aimed to evaluate the efficacy and feasibility of a perioperative Bloodless Medicine and Surgery (BMS) protocol in reducing severe postoperative anemia (Hb <7 g/dL) in Jehovah’s Witnesses (JWs) undergoing cytoreductive surgery for advanced epithelial ovarian cancer (AEOC).
Methods This was a single-institution retrospective study enrolling JWs who underwent elective bloodless surgery for AEOC between October 2017 and April 2020. All patients followed a standardized BMS protocol based on ferric carboxymaltose (FCM) and erythropoietin (EPO) if indicated.
Results Twenty-five patients with a mean age of 61.7 years (range, 35–80) were enrolled. Preoperatively, 10 patients (40%) were mildly anemic (mean Hb of 10.2 g/dL [range, 9.2–11.4]) and received FCM. Only 4 (16%) patients had severe anemia after surgery (mean Hb of 6.1 g/dL [range, 4.1–6.9]) and received FCM and EPO. Compared to patients with postoperative Hb >7 g/dL, those with Hb <7 g/dL reported higher mean BMI (25.8±1.8 vs 30.7±1.8 kg/m2; p<0.001), mean baseline CA125 (236.1±184.5 vs 783.7±273.5 IU/mL; p<0.001), median surgical complexity score (2 vs 10; p<0.001), and postoperative overall complications (100% vs 14.3%; p<0.001). Moreover, these patients showed longer mean operating time (3.4±0.6 vs 5.5±0.4 h; p<0.001), hospital length of stay (5.5±0.7 vs 24.0±9.8 days; p<0.001), and time to adjuvant chemotherapy (27.2±2.6 vs 65.3±13.4 days; p<0.001).
Conclusions The use of a multidisciplinary BMS protocol is safe and effective in reducing the rate of severe postoperative anemia and improving surgical and oncological outcomes of JWs with AEOC. Further large-scale, prospective studies are required to confirm these data.
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