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Stoleriu MG, Gerckens M, Zimmermann J, Schön J, Damirov F, Samm N, Kovács J, Stacher-Priehse E, Kellerer C, Jörres RA, Kauke T, Ketscher C, Grützner U, Hatz R. Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center. BMC Surg 2023; 23:44. [PMID: 36849951 PMCID: PMC9972742 DOI: 10.1186/s12893-023-01924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Our study aimed to identify preoperative predictors for perioperative allogenic blood transfusion (ABT) in patients undergoing major lung cancer resections in order to improve the perioperative management of patients at risk for ABT. METHODS Patients admitted between 2014 and 2016 in a high-volume thoracic surgery clinic were retrospectively evaluated in a cohort study based on a control group without ABT and the ABT group requiring packed red blood cell units within 15 days postoperatively until discharge. The association of ABT with clinically established parameters (sex, preoperative anemia, liver and coagulation function, blood groups, multilobar resections) was analyzed by contingency tables, receiver operating characteristics (ROC) and logistic regression analysis, taking into account potential covariates. RESULTS 60 out of 529 patients (11.3%) required ABT. N1 and non-T1 tumors, thoracotomy approach, multilobar resections, thoracic wall resections and Rhesus negativity were more frequent in the ABT group. In multivariable analyses, female sex, preoperative anemia, multilobar resections, as well as serum alanine-aminotransferase levels, thrombocyte counts and Rhesus negativity were identified as independent predictors of ABT, being associated with OR (95% Confidence interval, p-value) of 2.44 (1.23-4.88, p = 0.0112), 18.16 (8.73-37.78, p < 0.0001), 5.79 (2.50-13.38, p < 0.0001), 3.98 (1.73-9.16, p = 0.0012), 2.04 (1.04-4.02, p = 0.0390) and 2.84 (1.23-6.59, p = 0.0150), respectively. CONCLUSIONS In patients undergoing major lung cancer resections, multiple independent risk factors for perioperative ABT apart from preoperative anemia and multilobar resections were identified. Assessment of these predictors might help to identify high risk patients preoperatively and to improve the strategies that reduce perioperative ABT.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany. .,Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377, Munich, Germany. .,Asklepios Lung Clinic Munich-GautingDivision of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU) and Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany.
| | - Michael Gerckens
- grid.4567.00000 0004 0483 2525Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Julia Zimmermann
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Johannes Schön
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Fuad Damirov
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Nicole Samm
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Julia Kovács
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Elvira Stacher-Priehse
- Department of Pathology, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Christina Kellerer
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany ,grid.6936.a0000000123222966School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstr. 47, 81667 Munich, Germany
| | - Rudolf A. Jörres
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany
| | - Teresa Kauke
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Ketscher
- Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Uwe Grützner
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Rudolf Hatz
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
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Pérez-Rodríguez PA, Eraso-Villota MI, Cardona-Gallardo MA, Castrillón-Pineda AI, Torres-España NF, Fernández-Trujillo L, Sánchez-Ortiz ÁI, Velásquez-Galvis M. Lobectomías pulmonares en Colombia: una caracterización demográfica y clínico-patológica. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introducción. La lobectomía pulmonar es uno de los procedimientos más frecuentes en la cirugía torácica en Colombia y a nivel mundial. El objetivo de este estudio fue proporcionar información sobre el comportamiento clínico de los individuos sometidos a este tipo de cirugías.
Métodos. Estudio observacional retrospectivo en un Hospital Universitario de Cali, Colombia, que incluyó todos los pacientes sometidos a lobectomía pulmonar, por causas benignas o malignas, entre los años 2010 y 2020. La información se extrajo del registro institucional de cirugía de tórax, obteniendo datos demográficos, clínicos y patológicos.
Resultados. Se evaluaron los registros clínicos de 207 individuos. El 55,5 % eran mujeres, la edad promedio fue 58 años y el 41 % tuvieron antecedente de tabaquismo. En el 51,6 % de los casos se diagnosticaron neoplasias, de las cuales el 47,8 % eran primarias de pulmón, siendo el adenocarcinoma el subtipo más común. Las enfermedades benignas no tumorales representaron el 48,3 % de los casos y la causa más frecuente fueron las infecciones, dentro de las que se incluyeron 17 casos de tuberculosis pulmonar. La técnica más frecuente fue la cirugía toracoscópica video asistida (82,6 %). Presentaron un porcentaje de reintervención del 5,8 %, 10,6 % de complicaciones severas y una mortalidad hospitalaria del 4,3 %.
Conclusión. La población evaluada muestra una carga alta de comorbilidades y riesgo operatorio elevado; de forma consecuente, al compararla con otras series internacionales, se encontró un porcentaje mayor de complicaciones perioperatorias y mortalidad.
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Hong Y, Zhang Y, Xiang Y, Ye Z, Lu X. Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1478. [PMID: 34734030 PMCID: PMC8506730 DOI: 10.21037/atm-21-4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/18/2021] [Indexed: 11/06/2022]
Abstract
Background Venous thromboembolism (VTE) and postoperative bleeding are important complications of lung resection surgery. We investigated the preventive effect of mechanical prophylaxis versus pharmacological prophylaxis after lobectomy, and evaluated the effect of both on the incidence of hemorrhagic events. Methods A prospective study of 424 lobectomies with moderate to high risk of VTE (Caprini risk score <5) in a single center was performed from April 2020 to March 2021. Patients were 1:1 randomly allocated to mechanical prophylaxis or to the low-molecular-weight heparin (LMWH)-combination-prophylaxis. The incidence of postoperative thrombotic and bleeding events and relevant factors of the two groups were analyzed. Results A total of 410 participants, with 202 and 208 in the mechanical prophylaxis and LMWH-combination-prophylaxis groups respectively, were selected for analysis. Both groups had similar baseline and clinical characteristics. There were no cases of VTE or major bleeding during the study, but the incidence rate of minor bleeding in the LMWH-combination-prophylaxis group was significantly higher than mechanical prophylaxis group [odds ratio (OR) 0.035, 95% confidence interval (CI): 0.011–0.113]. Conclusions A case-by-case risk assessment of VTE and hemorrhage remains necessary to determine the most appropriate method of thrombosis prophylaxis for patients undergoing pulmonary surgery. Mechanical prophylaxis may be preferable for lung cancer patients with moderate to high risk of VTE (Caprini risk score <5) undergoing lobectomy. Trial Registration Chinese Clinical Trial Registry ChiCTR2100051073.
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Affiliation(s)
- Yun Hong
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanfang Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yangwei Xiang
- Department of Lung Transplantation and Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziqi Ye
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyang Lu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E. Association between the computed tomography findings and operative time for interval appendectomy in children. Afr J Paediatr Surg 2021; 18:73-78. [PMID: 33642402 PMCID: PMC8232362 DOI: 10.4103/ajps.ajps_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose was to evaluate the association between operative time and findings noted on computed tomography (CT) immediately before interval appendectomy. MATERIALS AND METHODS Forty-two children who underwent CT before interval appendectomy were included. We evaluated the association between operative time and these image findings: (1) appendicolith, (2) increased intra-abdominal fat density around the appendix, (3) location of the appendix, (4) ascites, (5) abscess formation and (6) maximum appendix outer wall diameter. Appendix location was classified as (#1) just below the anterior abdominal wall; (#2) retrocaecal or retro-ascending colon and (#3) pelvic. Results were analysed using Pearson's correlation coefficient or Mann-Whitney U test. RESULTS The mean patient age and operative time were 116.24 ± 38.66 months (range, 31-195) and 67.76 ± 31.23 min (range, 30-179), respectively. Ascites was detected in only one case, and no abscess occurred in any patient; therefore, these findings were not analysed. Factors that significantly prolonged the operative time included increased intra-abdominal fat density around the appendix (absent, 59.43 ± 22.14 [range, 30-108] vs. present, 84.43 ± 40.13 [range, 32-179] min; P = 0.03) and retrocaecal or retro-ascending colon appendix (location 1, 40.83 ± 8.35 [range, 30-50]; location 2, 99.25 ± 18.56 [range, 74-135]; location 3, 64.54 ± 30.22 [range, 30-179] min; P < 0.01). There was a weak but significant association between maximum appendix outer wall diameter and operative time (R = 0.353; P = 0.02). CONCLUSION These pre-operative CT findings are important predictors of operative time for interval appendectomy. Radiologists and surgeons should use these specific image findings to predict the operative time and need for additional procedures during an interval appendectomy.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Kawamura T, Suzuki H, Kiyoshima M. Delayed postoperative bleeding following lobectomy caused by the sharp tip of a suture: a case report. Surg Case Rep 2020; 6:261. [PMID: 33025247 PMCID: PMC7538496 DOI: 10.1186/s40792-020-01039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Postoperative bleeding is a rare but serious complication occasionally caused by hard surgical materials, such as staples. Postoperative hemorrhage caused by sutures is very rare. Case presentation A 75-year-old man with lung cancer underwent right lower lobectomy. Eleven days after surgery, he developed a haemothorax. Emergency thoracotomy revealed arterial bleeding from a pinhole injury in the parietal pleura caused by a monofilament non-absorbable suture tip used during the initial surgery. Conclusions Postoperative bleeding is a serious complication, and as sutures are often used in surgery, it is important to be cautious while using this material.
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Affiliation(s)
- Tomoyuki Kawamura
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Hisashi Suzuki
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan.
| | - Moriyuki Kiyoshima
- Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan
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Smith D, Raices M, Diego C, Julián D, Montagne J, Dietrich A. Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis. J Thromb Thrombolysis 2020; 51:997-1004. [PMID: 32929687 DOI: 10.1007/s11239-020-02277-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as "high risk of bleeding" is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54-5.43), and early postoperative bleeding was 10.05% (95% CI 7.14-13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.
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Affiliation(s)
- David Smith
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina.
| | - Carolina Diego
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Drago Julián
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Juan Montagne
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Agustín Dietrich
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
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