Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study.
Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study.
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DOI：
10.1186/s12893-018-0360-0
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发表时间：
2018-05-23
期刊：
影响因子：
1.9
通讯作者：
Che G
中科院分区：
文献类型：
--
作者：
Li S;Zhou K;Lai Y;Shen C;Wu Y;Che G
本研究旨在评估非小细胞肺癌（NSCLC）患者接受电视胸腔镜（VATS）肺叶切除术时估计术中失血量（EIBL）对术后心肺并发症（PCC）的影响。我们对2015年4月至2016年2月期间在我机构连续患者的临床数据进行了单中心回顾性分析。初步评估PCC组和非PCC组之间的人口统计学差异。采用受试者工作特征（ROC）分析确定EIBL预测PCCs的阈值。进一步评估了按此临界值划分的两组患者之间PCC发生率和住院时间的人口统计学差异。最后建立了一个多变量Logistic回归模型，包括临床病理参数，P值< 0.05，以确定PCCs的独立危险因素。共纳入429例可手术NSCLC患者，其中80例发生PCC（发生率= 18.6%）。PCC组的EIBL均值（133.3 ± 191.3）mL显著高于非PCC组（79.1 ± 107.1）mL（P < 0.001）。ROC分析显示，EIBL为100 mL的阈值时，联合灵敏度（50.0%）和特异性（73.4%）是最大的。EIBL≥100 mL组PCC发生率明显高于EIBL< 100 mL组（30.1vs.13.5%，P < 0.001）。EIBL≥100 mL患者的住院时间和胸管留置时间均明显延长。最后，通过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可作为非小细胞肺癌VATS肺叶切除术后心肺并发症的重要分类预测因子。胸外科医生应尽量减少EIBL，并努力实现“无血”目标，以优化手术结果。本文的在线版本（10.1186/s12893-018-0360-0）包含补充材料，可供授权用户使用。
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. The online version of this article (10.1186/s12893-018-0360-0) contains supplementary material, which is available to authorized users.
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影响因子：
2.2
作者：
Margonis, Georgios A.;Kim, Yuhree;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
动脉血气可以预测I期非小细胞肺癌患者的长期预后。
影响因子：
1.9
作者：
Mizuguchi S;Iwata T;Izumi N;Tsukioka T;Hanada S;Komatsu H;Nishiyama N
通讯作者：
Nishiyama N
影响因子：
2.7
作者：
Mizuno, Akira;Kanda, Mitsuro;Kodera, Yasuhiro
通讯作者：
Kodera, Yasuhiro
DOI：
10.1097/00005373-199205000-00013
发表时间：
1992-05-01
影响因子：
--
作者：
CUE, JI;PEYTON, JC;MALANGONI, MA
通讯作者：
MALANGONI, MA
影响因子：
2.8
作者：
Li, Shuangjiang;Wang, Zhiqiang;Che, Guowei
通讯作者：
Che, Guowei