Transfusion Risk in Open, Laparoscopic, and Robotic-Assisted Surgery: A Propensity Score Matched Case-Control Study across Surgical Disciplines

We conducted a large case-control study to compare the effect of surgical approach on blood transfusion requirements and patient outcomes across multiple surgical disciplines. Using data from the German Patient Blood Management Network, we analyzed 15,009 matched patient pairs who underwent urological, visceral, or thoracic surgery between 2010 and 2019. We used propensity score matching to compare robotic-assisted surgery, laparoscopic surgery, and open surgery, evaluating red blood cell (RBC) transfusion rates, perioperative hemoglobin changes, and length of hospital stay.

Main Outcomes

• Robotic-assisted vs. open surgery: Robotic approach reduced transfusion risk by 68% (RR: 0.32, 95% CI: 0.27–0.37), preserved hemoglobin better (0.40 g/dL higher postoperatively), and shortened hospital stay by 4.29 days
• Robotic-assisted vs. laparoscopic surgery: No significant difference in transfusion rates (RR: 0.94, 95% CI: 0.75–1.18) or hospital stay, with minimal difference in hemoglobin preservation (0.27 g/dL)
• Highest transfusion rates: Open surgery on large intestine (2,569 RBC units/1,000 patients), small intestine (2,152 units), and lung (1,642 units)
• Lowest transfusion rates: Radical prostatectomy consistently showed lowest rates across all approaches (300 units/1,000 for open, 179 for robotic, 147 for laparoscopic)

Limitations

• Retrospective design: Potential for unmeasured confounders despite propensity score matching
• Surgeon experience: Study did not account for individual surgeon skill or years of experience
• Follow-up data: No post-discharge data available to assess longer-term outcomes

Conclusion

Both robotic-assisted and laparoscopic surgery significantly reduce blood transfusion requirements compared to open surgery, supporting the advancement of minimally invasive procedures as an important Patient Blood Management measure. While both minimally invasive approaches offer similar benefits, the choice between robotic and laparoscopic techniques showed no clear advantage for either approach regarding transfusion risk. This highlights the importance of expanding access to any minimally invasive surgical option to optimize patient outcomes and reduce transfusion-related complications.

Cite

Rumpf F, Choorapoikayil S, Hof L, et al. Transfusion Risk in Open, Laparoscopic, and Robotic-Assisted Surgery: A Propensity Score Matched Case-Control Study across Surgical Disciplines. Transfus Med Hemother. 2024;52(2):142-151. Published 2024 Oct 21. doi:10.1159/000540981