Bastian Grande1,2, Pascal Oechslin1, Martin Schlaepfer1,3, Burkhardt Seifert4, Ilhan Inci5, Isabelle Opitz5, Donat R Spahn1, Walter Weder5, Marco Zalunardo1. 1. Department of Anesthesiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. 2. Simulation Center, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. 3. Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland. 4. Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. 5. Department of Thoracic Surgery, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Abstract
BACKGROUND: This retrospective study aims to identify clinical predictors of intraoperative blood loss during lung transplantation. While for other surgical specialties predictors of blood loss have been identified such as previous likewise located surgery, poor preoperative health status of patients, blood coagulation status, and use of extra corporeal circulation, predictors of blood loss during lung transplantation are not yet established. METHODS: A total of 326 lung transplants were performed between January 2000 and February 2014 at a tertiary hospital. The primary aim was to associate blood loss with the following potential predictors: pulmonary arterial hypertension, pre- or intraoperative extracorporeal life support (ECLS), previous thoracic surgery, previous lung transplant, and Charlson Comorbidity Index (CCI). Postoperative complications and 30-day mortality were secondary endpoints of the study. RESULTS: Median estimated blood loss during lung transplant was 1,500 mL (IQR, 1,000-2,875 mL). Pre- and intraoperative ECLS (P=0.02, P<0.001) independently increased blood loss by 59% and 107%, respectively. The higher blood loss during re-transplant marginally missed the significance level (P=0.05). Pulmonary arterial hypertension, previous thoracic surgery and high CCI were not associated with increased blood loss. As secondary outcomes, postoperative complications were more common in patients with a higher blood loss (P=0.04) but was not associated with higher 30-day mortality (P=0.18). CONCLUSIONS: Pre- and intraoperative ECLS were significant risk factors for higher blood loss during lung transplantation. Higher blood loss was associated with higher incidence of postoperative complications but not with a higher 30-day mortality. 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: This retrospective study aims to identify clinical predictors of intraoperative blood loss during lung transplantation. While for other surgical specialties predictors of blood loss have been identified such as previous likewise located surgery, poor preoperative health status of patients, blood coagulation status, and use of extra corporeal circulation, predictors of blood loss during lung transplantation are not yet established. METHODS: A total of 326 lung transplants were performed between January 2000 and February 2014 at a tertiary hospital. The primary aim was to associate blood loss with the following potential predictors: pulmonary arterial hypertension, pre- or intraoperative extracorporeal life support (ECLS), previous thoracic surgery, previous lung transplant, and Charlson Comorbidity Index (CCI). Postoperative complications and 30-day mortality were secondary endpoints of the study. RESULTS: Median estimated blood loss during lung transplant was 1,500 mL (IQR, 1,000-2,875 mL). Pre- and intraoperative ECLS (P=0.02, P<0.001) independently increased blood loss by 59% and 107%, respectively. The higher blood loss during re-transplant marginally missed the significance level (P=0.05). Pulmonary arterial hypertension, previous thoracic surgery and high CCI were not associated with increased blood loss. As secondary outcomes, postoperative complications were more common in patients with a higher blood loss (P=0.04) but was not associated with higher 30-day mortality (P=0.18). CONCLUSIONS: Pre- and intraoperative ECLS were significant risk factors for higher blood loss during lung transplantation. Higher blood loss was associated with higher incidence of postoperative complications but not with a higher 30-day mortality. 2019 Journal of Thoracic Disease. All rights reserved.
Entities:
Keywords:
Blood loss; extracorporeal life support (ECLS); lung transplantation; thoracic surgery
Authors: R K Spence; J A Carson; R Poses; S McCoy; M Pello; J Alexander; J Popovich; E Norcross; R C Camishion Journal: Am J Surg Date: 1990-03 Impact factor: 2.565
Authors: Tiago N Machuca; Stephane Collaud; Olaf Mercier; Maureen Cheung; Valerie Cunningham; S Joseph Kim; Sassan Azad; Lianne Singer; Kazuhiro Yasufuku; Marc de Perrot; Andrew Pierre; Karen McRae; Thomas K Waddell; Shaf Keshavjee; Marcelo Cypel Journal: J Thorac Cardiovasc Surg Date: 2014-11-21 Impact factor: 5.209
Authors: Christian A Bermudez; Akira Shiose; Stephen A Esper; Norihisa Shigemura; Jonathan D'Cunha; Jay K Bhama; Thomas J Richards; Peter Arlia; Maria M Crespo; Joseph M Pilewski Journal: Ann Thorac Surg Date: 2014-10-22 Impact factor: 4.330
Authors: Fabio Ius; Christian Kuehn; Igor Tudorache; Wiebke Sommer; Murat Avsar; Dietmar Boethig; Thomas Fuehner; Jens Gottlieb; Marius Hoeper; Axel Haverich; Gregor Warnecke Journal: J Thorac Cardiovasc Surg Date: 2012-08-31 Impact factor: 5.209
Authors: Denise Weber; Silvia R Cottini; Pascal Locher; Urs Wenger; Paul A Stehberger; Mario Fasshauer; Reto A Schuepbach; Markus Béchir Journal: Perioper Med (Lond) Date: 2013-09-27