Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study
Shuangjiang Li, Kun Zhou, Yutian Lai, Cheng Shen, Yanming Wu, Guowei Che, Shuangjiang Li, Kun Zhou, Yutian Lai, Cheng Shen, Yanming Wu, Guowei Che
Abstract
Background: The purpose of our study was to estimate the influence of estimated intraoperative blood loss (EIBL) on postoperative cardiopulmonary complications (PCCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC).
Methods: We conducted a single-center retrospective analysis on the clinical data of consecutive patients in our institution between April 2015 and February 2016. Demographic differences between PCC group and non-PCC group were initially assessed. Receiver operating characteristic (ROC) analysis was performed to determine the threshold value of EIBL for the prediction of PCCs. Demographic differences in the PCC rates and length of stay between two groups of patients divided by this cutoff were further evaluated. A multivariable logistic-regression model involving the clinicopathological parameters with P-value< 0.05 was finally established to identify independent risk factors for PCCs.
Results: A total of 429 patients with operable NSCLC were included and 80 of them developed PCCs (rate = 18.6%). The mean EIBL in PCC group was significantly higher than that in non-PCC group (133.3 ± 191.3 vs. 79.1 ± 107.1 mL; P < 0.001). The ROC analysis showed an EIBL of 100 mL as the threshold value at which the joint sensitivity (50.0%) and specificity (73.4%) was maximal. The PCC rate in patients with EIBL≥100 mL was significantly higher than that in patients with EIBL< 100 mL (30.1 vs. 13.5%; P < 0.001). Both the length of stay and chest tube duration were significantly prolonged in the patients with EIBL≥100 mL. Finally, EIBL≥100 mL was identified to be predictive of PCCs by multivariable logistic-regression analysis (odds ratio = 3.01; 95% confidence interval = 1.47-6.16; P = 0.003).
Conclusions: EIBL serves as a significant categorical predictor for cardiopulmonary complications following VATS lobectomy for NSCLC. Thoracic surgeons should minimize the EIBL and strive for the 'bloodless' goal to optimize surgical outcomes.
Keywords: Blood loss; Cardiopulmonary complications; Non-small-cell lung cancer; Prediction; Video-assisted thoracoscopic surgery.
Conflict of interest statement
Ethics approval and consent to participateThis study was approved by the ethics committee of Sichuan University West China Hospital, and relevant procedures were in compliance with the Helsinki Declaration. Written informed consent forms about this procedure were obtained for all surgical patients.
Competing interestsThe authors declare that they have no competing interests.
Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Figures
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Fig. 4
Kaplan-Meier curve revealing the length…
Fig. 4
Kaplan-Meier curve revealing the length of chest tube drainage between patients with EIBL≥100…
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- Aged
- Blood Loss, Surgical*
- Carcinoma, Non-Small-Cell Lung / surgery*
- Female
- Humans
- Length of Stay
- Logistic Models
- Lung Neoplasms / surgery*
- Male
- Middle Aged
- Pneumonectomy / adverse effects
- Pneumonectomy / methods*
- Postoperative Complications / etiology
- ROC Curve
- Retrospective Studies
- Risk Factors
- Thoracic Surgery, Video-Assisted
- Full Text Sources
- Other Literature Sources
- Medical
- Miscellaneous
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