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 participate

This 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 interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Histogram showing the distribution of estimated intraoperative blood loss
Fig. 2
Fig. 2
Receiver operating characteristic analysis on the discriminative power of estimated intraoperative blood loss for predicting postoperative cardiopulmonary complication
Fig. 3
Fig. 3
Kaplan-Meier curve revealing the length of stay between patients with EIBL≥100 mL and with EIBL

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…

Fig. 4
Kaplan-Meier curve revealing the length of chest tube drainage between patients with EIBL≥100 mL and with EIBL
Similar articles
Cited by
References
    1. Li S, Wang Z, Huang J, Fan J, Du H, Liu L, et al. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg. 2017;51(5):817–828. - PubMed
    1. Li S, Zhou K, Du H, Shen C, Li Y, Che G. Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study. BMC Surg. 2017;17(1):69. doi: 10.1186/s12893-017-0264-4. - DOI - PMC - PubMed
    1. Mizuguchi S, Iwata T, Izumi N, Tsukioka T, Hanada S, Komatsu H, et al. Arterial blood gases predict long-term prognosis in stage I non-small cell lung cancer patients. BMC Surg. 2016;16:3. doi: 10.1186/s12893-016-0119-4. - DOI - PMC - PubMed
    1. Liu C, Pu Q, Guo C, Xiao Z, Mei J, Ma L, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg. 2015;15:38. doi: 10.1186/s12893-015-0025-1. - DOI - PMC - PubMed
    1. Kanzaki M, Isaka T, Kikkawa T, Sakamoto K, Yoshiya T, Mitsuboshi S, et al. Binocular stereo-navigation for three-dimensional thoracoscopic lung resection. BMC Surg. 2015;15:56. doi: 10.1186/s12893-015-0044-y. - DOI - PMC - PubMed
Show all 34 references
MeSH terms
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig. 4
Fig. 4
Kaplan-Meier curve revealing the length of chest tube drainage between patients with EIBL≥100 mL and with EIBL

References

    1. Li S, Wang Z, Huang J, Fan J, Du H, Liu L, et al. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg. 2017;51(5):817–828.
    1. Li S, Zhou K, Du H, Shen C, Li Y, Che G. Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study. BMC Surg. 2017;17(1):69. doi: 10.1186/s12893-017-0264-4.
    1. Mizuguchi S, Iwata T, Izumi N, Tsukioka T, Hanada S, Komatsu H, et al. Arterial blood gases predict long-term prognosis in stage I non-small cell lung cancer patients. BMC Surg. 2016;16:3. doi: 10.1186/s12893-016-0119-4.
    1. Liu C, Pu Q, Guo C, Xiao Z, Mei J, Ma L, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg. 2015;15:38. doi: 10.1186/s12893-015-0025-1.
    1. Kanzaki M, Isaka T, Kikkawa T, Sakamoto K, Yoshiya T, Mitsuboshi S, et al. Binocular stereo-navigation for three-dimensional thoracoscopic lung resection. BMC Surg. 2015;15:56. doi: 10.1186/s12893-015-0044-y.
    1. Laursen LØ, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg. 2016;49(3):870–875. doi: 10.1093/ejcts/ezv205.
    1. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139(2):366–378. doi: 10.1016/j.jtcvs.2009.08.026.
    1. Li S, Zhou K, Wang M, Lin R, Fan J, Che G. Degree of pulmonary fissure completeness can predict postoperative cardiopulmonary complications and length of hospital stay in patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer. Interact Cardiovasc Thorac Surg. 2018;26(1):25–33. doi: 10.1093/icvts/ivx261.
    1. Nojiri T, Inoue M, Takeuchi Y, Maeda H, Shintani Y, Sawabata N, et al. Impact of cardiopulmonary complications of lung cancer surgery on long-term outcomes. Surg Today. 2015;45(6):740–745. doi: 10.1007/s00595-014-1032-z.
    1. Asakura K, Mitsuboshi S, Tsuji M, Sakamaki H, Otake S, Matsuda S, et al. Pulmonary arterial enlargement predicts cardiopulmonary complications after pulmonary resection for lung cancer: a retrospective cohort study. J Cardiothorac Surg. 2015;10:113. doi: 10.1186/s13019-015-0315-9.
    1. Nakamura H, Saji H, Kurimoto N, Shinmyo T, Tagaya R. Impact of intraoperative blood loss on long-term survival after lung cancer resection. Ann Thorac Cardiovasc Surg. 2015;21(1):18–23. doi: 10.5761/atcs.oa.13-00312.
    1. Margonis GA, Kim Y, Samaha M, Buettner S, Sasaki K, Gani F, et al. Blood loss and outcomes after resection of colorectal liver metastases. J Surg Res. 2016;202(2):473–480. doi: 10.1016/j.jss.2016.01.020.
    1. Mizuno A, Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, et al. Adverse effects of intraoperative blood loss on long-term outcomes after curative Gastrectomy of patients with stage II/III gastric Cancer. Dig Surg. 2016;33(2):121–128. doi: 10.1159/000443219.
    1. Rahouma M, Kamel M, Ghaly G, Nasar A, Harrison S, Stiles B, et al. Intraoperative blood loss is an independent predictor of poor disease free survival for patients undergoing VATS lobectomy for lung Cancer: topic: surgery. J Thorac Oncol. 2016;11(11S):S297. doi: 10.1016/j.jtho.2016.09.080.
    1. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808. doi: 10.1136/.
    1. Li SJ, Zhou K, Shen C, Li PF, Wu YM, Wang ZQ, et al. Body surface area: a novel predictor for conversion to thoracotomy in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. J Thorac Dis. 2017;9(8):2383–2396. doi: 10.21037/jtd.2017.07.53.
    1. Li SJ, Zhou K, Wu YM, Wang MM, Shen C, Wang ZQ, et al. Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. J Thorac Dis. 2018;10(1):416–431. doi: 10.21037/jtd.2017.12.70.
    1. Li S, Wang Z, Zhou K, Wang Y, Wu Y, Li P, et al. Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study. Ther Clin Risk Manag. 2018;14:461–474. doi: 10.2147/TCRM.S159632.
    1. Fernandez FG, Falcoz PE, Kozower BD, Salati M, Wright CD, Brunelli A. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: joint standardization of variable definitions and terminology. Ann Thorac Surg. 2015;99(1):368–376. doi: 10.1016/j.athoracsur.2014.05.104.
    1. Liu L, Che G, Pu Q, Ma L, Wu Y, Kan Q, et al. A new concept of endoscopic lung cancer resection: single-direction thoracoscopic lobectomy. Surg Oncol. 2010;19(2):e71–e77. doi: 10.1016/j.suronc.2009.04.005.
    1. Lai Y, Su J, Qiu P, Wang M, Zhou K, Tang Y, et al. Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial. Interact Cardiovasc Thorac Surg. 2017;25(3):476–483. doi: 10.1093/icvts/ivx141.
    1. Huang J, Lai Y, Zhou X, Li S, Su J, Yang M, et al. Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. J Thorac Dis. 2017;9(7):1919–1929. doi: 10.21037/jtd.2017.06.15.
    1. Zhou K, Su J, Lai Y, Li P, Li S, Che G. Short-term inpatient-based high-intensive pulmonary rehabilitation for lung cancer patients: is it feasible and effective? J Thorac Dis. 2017;9(11):4486–4493. doi: 10.21037/jtd.2017.10.105.
    1. Hickey GL, Dunning J, Seifert B, Sodeck G, Carr MJ, Burger HU, et al. Statistical and data reporting guidelines for the European journal of cardio-thoracic surgery and the interactive CardioVascular and thoracic surgery. Eur J Cardiothorac Surg. 2015;48(2):180–193. doi: 10.1093/ejcts/ezv168.
    1. D'Andrilli A, Cavaliere I, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, et al. Evaluation of the efficacy of a haemostatic matrix for control of intraoperative and postoperative bleeding in major lung surgery: a prospective randomized study. Eur J Cardiothorac Surg. 2015;48(5):679–683. doi: 10.1093/ejcts/ezu484.
    1. Dixon E, Datta I, Sutherland FR, Vauthey JN. Blood loss in surgical oncology: neglected quality indicator? J Surg Oncol. 2009;99(8):508–512. doi: 10.1002/jso.21187.
    1. Yamashita S, Tokuishi K, Moroga T, Abe S, Yamamoto K, Miyahara S, et al. Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg. 2013;95(3):994–999. doi: 10.1016/j.athoracsur.2012.11.005.
    1. Cué JI, Peyton JC, Malangoni MA. Does blood transfusion or hemorrhagic shock induce immunosuppression? J Trauma. 1992;32(5):613–617. doi: 10.1097/00005373-199205000-00013.
    1. Angele MK, Faist E. Clinical review: immunodepression in the surgical patient and increased susceptibility to infection. Crit Care. 2002;6(4):298–305. doi: 10.1186/cc1514.
    1. Searl CP, Perrino A. Fluid management in thoracic surgery. Anesthesiol Clin. 2012;30(4):641–655. doi: 10.1016/j.anclin.2012.08.009.
    1. Arslantas MK, Kara HV, Tuncer BB, Yildizeli B, Yuksel M, Bostanci K, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections. J Thorac Cardiovasc Surg. 2015;149(1):314–320. doi: 10.1016/j.jtcvs.2014.08.071.
    1. Adeniji K, Steel AC. The pathophysiology of perioperative lung injury. Anesthesiol Clin. 2012;30(4):573–590. doi: 10.1016/j.anclin.2012.08.011.
    1. Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol. 2012;25(1):1–10. doi: 10.1097/ACO.0b013e32834dd1eb.
    1. Perkins NJ, Schisterman EF. The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163(7):670–675. doi: 10.1093/aje/kwj063.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅