Safety and efficacy of acute normovolemic hemodilution during liver surgery: a Meta-analysis

Abstract

Abstract Objective The aim of this study was to evaluate the safety and efficacy of acute normovolemic hemodilution (ANH) during liver surgery. Methods Structured searches of the PubMed, Chinese Biological Medicine Database, and Cochrane Library electronic databases were performed, followed by a meta-analysis of outcomes, including intraoperative blood transfusion(s), intraoperative bleeding, postoperative hematocrit (Hct) levels, postoperative prothrombin time (PT), and number of patients who underwent transfusions during liver surgery. Results In total, 14 eligible studies were included in the meta-analysis, which revealed that ANH for liver resection was associated with a reduction in intraoperative blood transfusions [weighted mean difference (WMD) -1.99; 95% confidence interval (CI) -2.82 to -1.16; P < 0.00001]. The ANH group experienced less intraoperative bleeding (WMD -72.81; 95% CI -136.12 to -9.50; P < 0.00001) and exhibited a lower postoperative Hct level (WMD -3.38; 95% CI -7.14 to -0.67; P < 0.00001) than the control group. Moreover, meta-analysis revealed that postoperative prothrombin time was not affected by ANH (WMD -0.02; 95% CI -0.18 to -0.32; P = 0.65). Finally, the number of patients requiring allogeneic transfusion was significantly smaller in the ANH group than in the control group (odds ratio 0.13; 95% CI 0.09 to 0.18; P = 0.24). Conclusion Results of the present meta-analysis indicated that ANH can reduce intraoperative bleeding and the need for blood transfusions. In addition, ANH did not negatively affect the coagulation system after surgery; therefore, ANH appears to be safe and effective during liver surgery.