Blood use in lung resection for carcinoma: perioperative elective anaemia does not compromise the early outcome

Objective. Blood transfusion may adversely affect the prognosis following s urgery for non-small cell lung carcinoma (NSCLC). Conventionally by most th oracic surgeons, a perioperative haemoglobin (Hb) less than 10 g/dl has bee n considered a transfusion trigger. In this prospective trial we have (a) e valuated the overall blood transfusion requirements and factors associated with an increased need for transfusion and (b) in a subsequent subset of pa tients, tested the hypothesis that elective anaemia after major lung resect ion may be safely tolerated in the early postoperative period. Methods: A t otal of 198 (M/F 179/10, mean age 61.2, range 32-85 years) patients sufferi ng from NSCLC were submitted to pneumonectomy (n = 89), bilobectomy (n = 19 ) and lobectomy (n = 90). A rather strict protocol was used as a transfusio n strategy. The transfusion requirements were analyzed and seven parameters (gender, age > 65, preoperative Hb < 11.5 g/dl, chest wall resection, hist ory of previous thoracotomy, pneumonectomy and total blood loss) were stati stically evaluated by univariate and logistic regression analysis. Subseque ntly, according to the perioperative Hb level during the first 48 h, patien ts were divided into group, A (n = 49, Hb = 8.5-10) and group B (n = 149, H b > 10) with a view to estimate the risks of elective perioperative anaemia . Groups were comparable in terms of age, sex, type of operation performed, preoperative Hb, creatinine level, FEV1, arterial blood gases and history of heart disease. Results: The overall transfusion rate was 16%. Univariate analysis revealed that preoperative Hb < 11.5 g/dl (P < 0.01) and total bl ood loss (P < 0.0001) were associated with increased need for transfusion, but only the total blood loss was identified as an independent variable in multivariate analysis. Statistical analysis between groups A and B showed n o significant difference regarding postoperative morbidity and mortality: a telectasis (3 vs. 6), chest infection (2 vs. 9), sputum retention requiring bronchoscopy (5 vs. 12), admission ta intensive care unit (5 vs. 7), ARDS (0 vs. 3), postoperative hospital stay (7.7 +/- 2.6 vs. 9.1 +/- 3.8 days) a nd deaths (I vs. 3). Conclusions: The use of a strict transfusion strategy could help in reducing overall blood transfusion. Furthermore, a perioperat ive Hb of 8.5-10 g/dl could be considered safe in elective lung resections for carcinoma. (C) 2000 Elsevier Science B.V. All rights reserved.