Li Shuangjiang, Zhou Kun, Lai Yutian, Shen Cheng, Wu Yanming, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Surg. 2018 May 23;18(1):29. doi: 10.1186/s12893-018-0360-0.
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).
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.
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).
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.
我们研究的目的是评估估计术中失血量（EIBL）对接受电视辅助胸腔镜手术（VATS）肺叶切除术治疗非小细胞肺癌（NSCLC）患者术后心肺并发症（PCCs）的影响。
我们对2015年4月至2016年2月期间我院连续患者的临床资料进行了单中心回顾性分析。首先评估PCC组和非PCC组之间的人口统计学差异。进行受试者操作特征（ROC）分析以确定用于预测PCCs的EIBL阈值。进一步评估根据该临界值划分的两组患者在PCC发生率和住院时间方面的人口统计学差异。最终建立一个涉及P值<0.05的临床病理参数的多变量逻辑回归模型，以确定PCCs的独立危险因素。
共纳入429例可手术的NSCLC患者，其中80例发生PCCs（发生率=18.6%）。PCC组的平均EIBL显著高于非PCC组（133.3±191.3 vs. 79.1±107.1 mL；P<0.001）。ROC分析显示EIBL为100 mL时联合敏感度（50.0%）和特异度（73.4%）最大。EIBL≥100 mL患者的PCC发生率显著高于EIBL<100 mL患者（30.1%对13.5%；P<0.001）。EIBL≥100 mL患者的住院时间和胸管留置时间均显著延长。最终，多变量逻辑回归分析确定EIBL≥100 mL可预测PCCs（比值比=3.01；95%置信区间=1.47-6.16；P=0.003）。
EIBL是NSCLC患者VATS肺叶切除术后心肺并发症的重要分类预测指标。胸外科医生应尽量减少EIBL，努力实现“无血”目标以优化手术结果。
