Preoperative Type and Screen Before General Thoracic Surgery: A Nomogram to Reduce Unnecessary Tests

The evaluation of patient blood management in lung resection under thoracotomy

OBJECTIVE

Unnecessary blood preparation by surgeons adversely affects blood bank stocks and the healthcare system in many ways. In this study, it is aimed to evaluate the patient blood management strategy in patients in whom we performed lobectomy and pneumonectomy with thoracotomy.

METHODS

A total of 87 patients have been included in this study. Patient specific data, such as demographic information, laboratory information, preoperative blood ordering, and blood transfusion information have been recorded.

RESULTS

All patients were cross-matched, but only 32 (36.7%) of the patients received blood transfusions. Although a total of 264 units of blood had been reserved, the amount of blood used for transfusion was 68 (25.7%) units. The cross-match / transfusion rate was 3.88, the transfusion index was 0.78, and the transfusion probability was 36.7%. There is a positive and statistically significant correlation between the amount of blood allocated (r = 0.591, p = 0.00) and the duration of intensive care and hospital stay (r = 0.266, p = 0.013). There was also a positive and statistically significant correlation between the amount of blood used and the duration of intensive care and hospital stay (r = 0.422, p = 0.00) (r = 0.474, p = 0.00).

CONCLUSION

In elective lung resection performed by thoracotomy, the amount of blood wasted during the patient's blood preparation process is high. During the patient blood preparation process, institution-controlled programs should be implemented instead of subjective evaluation at the discretion of the surgeon Planning a patient-specific blood preparation process to alleviate the burden on the healthcare system may prove to be more efficient.

Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects

One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.