Maximum surgical blood order schedule for pancreatoduodenectomy: A long way from uniform applicability!

Background: Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable life-saving resource and poses a significant financial burden on healthcare systems. Aim: To determine patient-specific factors associated with intra-operative transfusions, and if intra-operative blood transfusions impact postoperative morbidity. Patients & methods: Analysis of consecutive patients undergoing pancreatoduodenectomy (PD) for pancreatic tumors. Results: A total of 384 patients underwent a classical PD with an estimated median blood loss of 200 cc and percentage transfused being 9.6%. Pre-existing hypertension, synchronous vascular resection, end-to-side pancreaticojejunostomy and nodal disease burden significantly associated with the need for intra-operative transfusions. Intra-operative blood transfusion not associated with postoperative morbidity. Conclusion: Optimization of MSBOS protocols for PD is required for more judicious use of blood products.