(P 305) COMPARISON OF GOAL-DIRECTED VERSUS EMPIRICAL TRANSFUSION MANAGEMENT IN PATIENTS WITH SEVERE HEMORRHAGE DURING RETROPERITONEAL TUMOR SURGERY

Objective: Retroperitoneal tumor resection carries a high risk of severe hemorrhage and coagulopathy, necessitating optimal transfusion strategies. Conventional empirical transfusion protocols lack precision, potentially leading to over- or under-transfusion. This study evaluated the efficacy of goal-directed transfusion management guided by the Century Clot® coagulation and platelet function analyzer (CPA) compared to empirical transfusion in patients undergoing retroperitoneal tumor surgery with massive bleeding.

Methods: This retrospective cohort study included patients who underwent retroperitoneal tumor resection at Peking University International Hospital (January 2019–May 2024) with intraoperative blood loss exceeding 20% of total blood volume. Patients were divided into a goal-directed group (n=127), managed using CPA-guided thresholds for fresh frozen plasma (FFP), fibrinogen (FIB), prothrombin complex concentrate (PCC), and platelet (PLT) transfusions, and a control group (n=254), receiving empirical 1:1 RBC: FFP ratio transfusions. Outcomes included intraoperative blood product utilization, postoperative complications, and hospitalization duration.

Results: Baseline characteristics, operative duration, and blood loss were comparable between groups. The goal-directed group demonstrated significantly lower intraoperative use of FFP (median 400 vs. 600 mL, P< 0.05), FIB (0 vs. 0–1 g, P< 0.001), and PCC (0 vs. 0–550 IU, P< 0.001), with no difference in RBC transfusion (P>0.05). Postoperative complication rates (acute kidney injury, deep vein thrombosis, Clavien-Dindo grade ≥3, and mortality) were similar (P>0.05). However, the goal-directed group had shorter median postoperative (16 vs. 20 days, P< 0.001) and total hospitalization (28 vs. 31 days, P< 0.001).

Conclusion: CPA-guided transfusion reduced FFP, FIB, and PCC utilization without increasing complications, while significantly shortening hospitalization. These findings support integrating viscoelastic testing into transfusion protocols for major surgeries with high bleeding risk. Prospective studies are needed to validate long-term outcomes and cost-effectiveness.