University of Oulu

Lammi, J. P., Eskelinen, M., Tuimala, J., Selander, T., Saarnio, J., & Rantanen, T. (2021). Perioperative changes in hemoglobin levels during major hepatopancreatic surgery in transfused and non-transfused patients. Scandinavian Journal of Surgery, 110(3), 407–413.

Perioperative changes in hemoglobin levels during major hepatopancreatic surgery in transfused and non-transfused patients

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Author: Lammi, J. P.1; Eskelinen, Matti1,2; Tuimala, Jarno3;
Organizations: 1Department of Surgery, Kuopio University Hospital, Kuopio, Finland
2School of Medicine, University of Eastern Finland, Kuopio, Finland
3Not affiliated, Helsinki, Finland
4Department of Surgery, Oulu University Hospital, Oulu, Finland
5School of Medicine, University of Eastern Finland, P.O. Box 100, FI-70029 KYS, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
Persistent link:
Language: English
Published: SAGE Publications, 2021
Publish Date: 2021-12-03


Background: Several studies have shown that restrictive transfusion policies are safe. However, in clinical practice, transfusion policies seem to be inappropriate. In order to assist in decision-making concerning red blood cell transfusions, we determined perioperative hemoglobin (Hb) levels during major pancreatic and hepatic operations.

Methods: Patients who underwent major pancreatic or hepatic resections between 2002 and 2011 were classified into the transfused (TF+) and non-transfused (TF) groups. The perioperative Hb values of these patients were evaluated at six points in time.

Results: The study included 1596 patients, of which 785 underwent pancreatoduodenectomy, 79 total pancreatectomy, and 732 partial hepatectomy. Similar perioperative changes in Hb levels were seen in all patients regardless of whether they received a blood transfusion. In patients undergoing pancreatoduodenectomy and total pancreatectomy, the median of the lowest measured hemoglobin values was 89.2 g/L and in partial hepatectomy patients 92.6 g/L, and these were assumed to be the trigger points for red blood cell transfusion.

Conclusions: Despite guidelines on blood transfusion thresholds, restrictive blood transfusion policies were not observed during our study period. After major pancreatic and hepatic surgery, Hb levels recovered without transfusions. This should encourage clinicians to obey the restrictive blood transfusion policies after major hepatopancreatic surgery.

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Series: Scandinavian journal of surgery
ISSN: 1457-4969
ISSN-E: 1799-7267
ISSN-L: 1457-4969
Volume: 110
Issue: 3
Pages: 407 - 413
Article number: 1457496920964362
DOI: 10.1177/1457496920964362
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the research foundation of Kuopio University Hospital and the EVO funding of the Hospital District of South Ostrobothnia.
Copyright information: © The Finnish Surgical Society 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (