Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

Abstract

Background: The rate of unplanned return to the operation room (UROR) is an important index for the quality of surgeries. Study of the features and causes of patients who have suffered UROR is key to reduce the risk of it. Methods: A retrospective, observational study was conducted among lung cancer patients who have received lung resections and UROR over a 5-year period. The causes, findings, procedures of UROR and recovery of patients were examined. Results: Among the 23,345 lung cancer surgeries, 64 underwent UROR with the rate being 0.27%.Lobectomy was performed in 78.1% of the patients. The most common indication was post-operative bleeding, responsible for 82.8% (53/64) of the cases. The median length of stay after the second surgery was 7 days and over 90% of the patients were discharged with proper recovery. The death rate within 90 days after return to operation room (OR) was 1.6% (1/64). In the 53 cases caused by bleeding, 27 (50.9%) occurred in surgical sites, with the raw surface of lymph node dissection being most frequently affected.Bleedings on incisions and unknown origin took up 11.3% and 37.7%, respectively. Conclusions: Bleeding is the most common indication which causes over 80% of UROR for lung cancer surgeries. Careful examination and complete hemostasis in surgery is key to reduce the risk of this unwanted complication.

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

“…The incidence of unplanned reoperation is 0.53% in our study, which is higher than the published 0.27% (after lung cancer surgeries) [8], probably due to the included benign tumors herein. Indeed, the benign tumors were reported to be more risky to postoperative bleedings than the malignant tumor, potentially due to inflammation [11].…”

“…Therefore, pulmonary parenchyma should be evaluated prior to the selection of a suitable and matched staple cartridge. Interestingly, one-third of these 31 hemothorax (10 cases) including 5 clotted hemothorax and 5 active hemorrhages, had no definite bleeding sites, accordant to the reported incidence (37.7–41%) [ 8 , 9 ], which can be attributed to chest wall vessels and may be ignored during reoperation via the initial incision [ 10 ]. Furthermore, our study indicated pleural adhesion is also a risk factor for the bleedings from the chest wall and pleural, especially in some “blind” areas, e.g., vicinity of incision and costophrenic angle.…”

“…However, some major postoperative complications still need unplanned surgical treatment, which increases hospital stay and medical costs, and even more intractable complications and higher mortality rate due to second injury and anesthesia [ 6 ]. The incidence of unplanned reoperation after VATS lobectomy was 0.27–3.5% [ 7 , 8 ], with the 90-day death 1.6% [ 8 ].…”

Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis

“…A plausible explanation for the recorded differences in the estimated blood loss between RATS and VATS may lie in the technical advantages provided by the robotic platform. The three-dimensional, magnified field of view, the elimination of tremor, and the more flexible equipment offered by RATS can allow surgeons to better identify anatomical relationships and control bleeding that occurs during the dissection of hilar and mediastinal lymph nodes, which represents an important source of blood loss during lung cancer surgery [ 32 ].…”

Unplanned reoperation after pulmonary surgery: Rate, risk factors and early outcomes at a single center

“…The incidence of unplanned reoperation after lung surgery ranges from 1.01% to 1.09% [ 2 , 5 ], while it varies between 0.27% and 1.76% in lung cancer surgery [ [6] , [7] , [8] ]. One study reported a decreasing trend of reoperation rate over time [ 8 ].…”