Brazilian Society of Surgical Oncology Guideline for Bloodless Surgery (Part 3: Postoperative Strategies)

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Abstract
Objective: To present postoperative strategies for bloodless surgery in oncologic patients, focusing on anemia management, bleeding control, oxygen delivery, and recovery without allogeneic blood transfusion. Methods: The Brazilian Society of Oncologic Surgery developed national recommendations for the rational use of blood products in surgical care. Between June and December 2024, a multidisciplinary panel of specialists reviewed the literature and formulated key questions covering preoperative, intraoperative, and postoperative management. Recommendations were graded using an adapted evidence classification system and validated through expert consensus. Results: Postoperative bloodless care should prioritize judicious laboratory testing to reduce iatrogenic anemia, targeted iron replacement, selective use of erythropoiesis‐stimulating agents, individualized hemostatic therapy, early recognition and control of hemorrhage, and optimization of oxygen delivery. General postoperative measures, including mobilization, analgesia, infection prevention, rehabilitation, and discharge planning, should be retained when directly related to anemia tolerance, blood conservation, or recovery in patients managed without transfusion. Conclusion: Postoperative bloodless surgery requires coordinated multidisciplinary care, early bleeding control, anemia treatment, oxygen delivery optimization, and careful follow‐up. These strategies may improve safety and recovery in oncologic patients who decline or require avoidance of allogeneic blood transfusion.

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