L Cirasino1, G Barosi, M Torre, S Crespi, P Colombo, P A Belloni. 1. Vergani and Brera Medical Divisions, the Division of Thoracic Surgery, and the Physical Health Service, Niguarda Ca' Granda Hospital, Milan, Italy. divisionevergani@tiscalinet.it
Abstract
BACKGROUND: The use of blood-saving techniques in elective surgery can produce a favorable cost-benefit ratio only when there is a reasonable likelihood that transfusion will be required. To apply a targeted blood-sparing technique in lung cancer surgery, the patient's preoperative characteristics that predict the use of allogeneic blood transfusion (ABT) in this practice were investigated. STUDY DESIGN AND METHODS: One hundred seventy-three consecutive patients who underwent primary lung cancer surgery were included in this retrospective study. Clinical and epidemiologic variables, lung tumor extension (TNM staging), and surgery type were analyzed by logistic regression to discover the preoperative predictors of ABT. RESULTS: Thirty patients, 17.3 percent of all who underwent surgery and 19.9 percent of those who underwent resolvent surgery, received ABT. Excluding a patient who needed 18 units of RBCs, the number of ABT units required by transfused patients was 1. 93 +/- 0.88 (mean +/- SD). Extensive surgery, patient's age (< or =64 years), and elevated erythrocyte sedimentation rate (>45 mm/hour) were the preoperative variables that influenced the need for ABT. The definitive predictive model was able to recognize 82.3 percent of patients who received ABT and 95.6 percent of those who did not. CONCLUSION: A predictive model can preoperatively identify patients at risk for needing ABT in lung cancer surgery. The model could be utilized to tailor blood-sparing intervention programs.
BACKGROUND: The use of blood-saving techniques in elective surgery can produce a favorable cost-benefit ratio only when there is a reasonable likelihood that transfusion will be required. To apply a targeted blood-sparing technique in lung cancer surgery, the patient's preoperative characteristics that predict the use of allogeneic blood transfusion (ABT) in this practice were investigated. STUDY DESIGN AND METHODS: One hundred seventy-three consecutive patients who underwent primary lung cancer surgery were included in this retrospective study. Clinical and epidemiologic variables, lung tumor extension (TNM staging), and surgery type were analyzed by logistic regression to discover the preoperative predictors of ABT. RESULTS: Thirty patients, 17.3 percent of all who underwent surgery and 19.9 percent of those who underwent resolvent surgery, received ABT. Excluding a patient who needed 18 units of RBCs, the number of ABT units required by transfused patients was 1. 93 +/- 0.88 (mean +/- SD). Extensive surgery, patient's age (< or =64 years), and elevated erythrocyte sedimentation rate (>45 mm/hour) were the preoperative variables that influenced the need for ABT. The definitive predictive model was able to recognize 82.3 percent of patients who received ABT and 95.6 percent of those who did not. CONCLUSION: A predictive model can preoperatively identify patients at risk for needing ABT in lung cancer surgery. The model could be utilized to tailor blood-sparing intervention programs.
Authors: Kent R Nilsson; Sean M Berenholtz; Todd Dorman; Elizabeth Garrett; Pamela Lipsett; Howard S Kaufman; Peter J Pronovost Journal: J Gastrointest Surg Date: 2002 Sep-Oct Impact factor: 3.452