Background : Blood loss and blood transfusion is a common consequence of hepatectomy. The Cavitron Ultrasonic Surgical Aspirator (CUSA) is used in parenchymal liver dissection. Blood loss and administration of blood transfusions have been associated with negative outcomes. We seek to identify if CUSA use affects the administration of blood following hepatectomy.

Methods : This study examines a retrospective cohort of patients from 2010 to 2023 undergoing hepatectomy for benign and malignant liver lesions. Major liver resection was defined as resection of 3 or more contiguous Couinaud segments. Chi-square test was used to assess for significant differences in the need for blood transfusion following surgery between groups.

Results : 342 patients were included. 69 (20.17%) patients required blood transfusion within 72 hours following their procedure. 94 (27.48%) patients underwent a major hepatectomy and 248 (72.51%) patients underwent a minor hepatectomy. 156 (45.61%) patients had parenchymal dissection with CUSA, in 185 (54.09%) patients Kelly-clysis was used. 57 (16.67%) patients were cirrhotic. The Chi-square test revealed that CUSA use was associated with less post-operative blood transfusions (p-value <0.001). In subgroup analysis of major and minor hepatectomy, CUSA was significantly associated with less chance of blood transfusion following minor liver resection (p-value=0.008), but not following major liver resection (p-value=0.105). Cirrhosis was not associated with increased need for blood transfusion (p-value=0.857).

Conclusions : CUSA use is associated with less need for administration of blood following hepatectomy compared with Kelly-clysis, this is particularly true following minor hepatectomy. Routine use of the CUSA device is likely to improve patient blood management following hepatectomy.