Reducing Red Blood Cell Transfusion Requirements for Adults Undergoing Surgical Resection of the Liver - A Quality Improvement Project

Inclusion Criteria: * Liver resection in this study is defined according to the PRICE-2 trial, involving 3 or more liver segments, such as right posterior sectionectomy (of segments VI and VII) as well as central resections involving segments IVb and V, along with expected blood loss of \>250 mL * in patients with known liver cirrhosis, resection of a full segment was included. Exclusion Criteria (defined according to the PRICE-2 trial): * current cardiac condition (e.g., MI within the last 6 months, hypertrophic cardiomyopathy, severe valvular disease, or other unstable coronary syndromes) * history of cerebrovascular disease (CVA within the past 6 months or severe carotid stenosis with more than 70% occlusion) * history of significant peripheral vascular disease (not yet revascularized with regular/ongoing claudication) * A current pregnancy * A documented, patient-declared refusal to undergo phlebotomy and transfusion * preoperative autologous blood donation * presence of active infection * preoperative hemoglobin \<100 g/L * GFR \<60 mL/min * platelets count \<100 × 109/L * Uncorrectable coagulopathies or other decompensated cardiac or respiratory conditions that would contraindicate acute volume depletion * undergoing emergency surgery * planned intraoperative use of cell salvage * inability to participate in follow up * in the case of repeat liver resections, previous participation in the trial