Hemorrhage in Robot-assisted Partial Nephrectomy: A Multicentric, Retrospective Analysis of Blood Transfusion and Bleeding Requiring Intervention in 3726 Cases

Background and objective: Postoperative bleeding in robot-assisted partial nephrectomy (RAPN) can result in a major complication. This study aims to identify factors associated with postoperative bleeding requiring an intervention (PBRI) as a major complication and predictors of blood transfusions as a minor complication. Methods: This study is a multicentric, retrospective analysis of 3726 RAPN cases. Separate comparative analysis was performed between: (1) patients with PBRI versus those without PBRI and (2) patients with blood transfusion versus those without blood transfusion. Two independent multivariable logistic regression analyses were performed to identify predictors for each endpoint. Key findings and limitations: < 0.001 for transfusion) were significantly associated with both complications.Main limitation of this study is its retrospective design. Conclusion and clinical implications: Most hemorrhagic complications after RAPN can be managed with kidney-preserving, multidisciplinary approaches. However, whether preoperative anemia correction is associated with improved outcomes should be investigated in future studies.