Petrella et al identifief factors associated with perioperative blood transfusion in a patient undergoing thoracic surgery for lung cancer. These factors can help to identify a patient who may benefit from more aggressive management. The authors are from the European Institute of Oncology and University of Milan in Italy.
Patient selection: thoracic surgery for malignancy
Exclusion: mesothelioma, emergency thoracotomy
Outcome: blood product transfusion
In general, the use of blood products in thoracic surgery is relatively low, with a quarter of patients receiving at least 1 unit of red blood cells.
Criteria for blood transfusion in study hospital:
(1) blood loss > 800 mL
(2) hemodynamic instability
(3) persistent postoperative hemoglobin < 8.0 g/dL
The main risk factor for red blood cell transfusion was preoperative hemoglobin concentration reflecting anemia.
Additional factors that can help to identify a patient who may need to be transfused with red blood cell products:
(1) low body mass index (< 25 kg per square meter, possibly reflecting cachexia and/or malnutrition)
(2) preoperative induction chemotherapy
(3) redo surgical procedure
(4) long procedure duration (which correlates with complexity of the procedure and/or a larger resection)
Although not mentioned, perioperative bleeding would be a reason to transfuse. The exclusion of emergency thoracotomy might have excluded patients with active bleeding. In Table 1 the mean blood loss for nontransfused patients was 104 mL with range from 0 to 600 mL. For the transfused population the mean was almost 200 mL with range from 0 to 2,500 mL. The p value was 0.483. Transfusion would be more likely with blood loss in the setting of preoperative anemia.
Fresh frozen plasma (FFP) was usually not given but may be needed in a patient with coagulopathy.
