Preoperative Anemia as a Risk Factor for Postoperative Outcomes in Patients Undergoing Lung Transplantation

Hernandez-Morgan, Marisa; Neelankavil, Jacques; Grogan, Tristan; Hong, B.; Wingert, Theodora; Methangkool, Emily

doi:10.1053/j.jvca.2020.10.045

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…First, in the setting of patients who have been waitlisted for some time, investigating and optimizing their baseline hemoglobin may help avoid the need for intraoperative PRBCs. Lower preoperative hemoglobin values have been shown to be associated with an increased risk of rebleeding and higher mortality at 1 y after LT. 32 Second, using pointof-care coagulation studies, transfusion algorithms, and factor concentrates has been shown to reduce blood transfusions after LT. [33][34][35][36] Third, several operative characteristics were identified as having a positive correlation with the use of more intraoperative PRBCs, including the use of intraoperative cardiopulmonary bypass (CPB) or ECMO, length of ECLS, and length of operation. 37,38 These variables are likely surrogates for a more complex surgical procedure at the time of LT. Avoidance of any mechanical circulatory support, use of ECMO rather than CPB, and a shorter procedure duration can all help to reduce transfusions and related lung injury, although these modifications may not be feasible in complex and sick recipients.…”

Section: Sd Minimum Maximummentioning

confidence: 99%

Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

et al. 2023

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Background. In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes. Methods. The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT. Results. We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1–4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly (P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001). Conclusions. In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.

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Section: Sd Minimum Maximummentioning

confidence: 99%

Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

et al. 2023

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“…Preoperative anemia is a well-known risk factor for increased morbidity and mortality in lung resection surgery (21,22). In lung transplantation, anemia (as defined by hemoglobin (Hg) <12 g/dL in women and 13 g/dL in men) is associated with increased LOS and higher risk of bleeding requiring redo surgery (23). Preoperative anemia in esophagectomy was associated with acute respiratory failure in one retrospective study, and while not independently associated with adverse short-term outcomes, was associated with higher red blood cell (RBC) transfusions which increased the risk of overall complication and surgical site infections (SSIs) (17,24).…”

Section: Anemia Correctionmentioning

confidence: 99%

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Al-Abri¹,

Shafiepour²

2023

Curr Chall Thorac Surg

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Background and Objective: Over the past two decades enhanced recovery after surgery (ERAS) pathways, which were established initially in colorectal surgery, have evolved and been adapted for other surgical disciplines. Goals include minimizing complications, optimizing recovery and an efficient return to preoperative baseline functioning. The introduction of ERAS pathways has led to both clinical benefits as well as cost savings. As these pathways consist of bundles of interventions throughout the perioperative period, the relative contribution of each individual component of these programs remains to be elucidated.The following narrative review article explores the application of ERAS principles to the thoracic surgery population. The evidence for individual components of these pathways will be discussed. Additionally, the introduction of prehabilitation interventions to the care of these patients will be explored. A brief case example is provided to illustrate how such interventions can aid in perioperative decision making.Methods: Medical computerized databases (PubMed and Cochrane Library) were searched for relevant reviews and guidelines published in English up to March 31, 2021, and hand searches of the references were performed. Articles were reviewed but no formal statistical analysis was undertaken.Key Content and Findings: Preoperative, intraoperative and postoperative elements of ERAS pathways were examined. Some elements, such as smoking cessation, have fairly robust evidence of benefit, but questions still remain regarding optimal duration of intervention especially when weighed against surgical delay. Others, for example preoperative carbohydrate loading, may lack significant evidence of improved outcomes but have been adopted widely because of ow perceived risk of harm. Formal prehabilitation programs show promise, particularly in the lung resection population.Conclusions: Implementation of ERAS pathways has benefited thoracic surgical patients, however there is varying strength with regards to the evidence for individual components. There is an ongoing need to better define the roles of individual elements of these pathways and to further advance knowledge regarding the optimal ways in which to apply some of them.

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“…Specifically, in the thoracic surgery population, preoperative anaemia has been associated with worse long-term survival after lung cancer resection in a study by Taylor et al [9 ▪▪ ] looking at 5029 patients with nonsmall cell lung cancer. It is associated with worse postoperative outcomes in patients undergoing lung transplantation, including longer hospital stay and increased risk for reoperation secondary to bleeding [8]. In addition, preoperative anaemia has been associated with an increased incidence of receiving perioperative transfusions, which is also linked to increased postoperative morbidity and mortality [2].…”

Section: Why Anaemia Is Harmfulmentioning

confidence: 99%

“…Preoperative anaemia has been independently associated with increased mortality, stroke, infection and higher transfusion rates in cardiac surgery patients [7]. In patients with chronic lung disease, anaemia may be particularly detrimental given its association with worsening hypoxia as disease progresses, a concern that may put patients undergoing thoracic surgery procedures at an increased risk of the perioperative effects of anaemia [8]. Specifically, in the thoracic surgery population, preoperative anaemia has been associated with worse long-term survival after lung cancer resection in a study by Taylor et al [9 ▪▪ ] looking at 5029 patients with nonsmall cell lung cancer.…”

Section: Why Anaemia Is Harmfulmentioning

confidence: 99%

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Lanigan

Wilkey²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively. Recent findingsAnaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions. SummaryPatients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.

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Preoperative Anemia as a Risk Factor for Postoperative Outcomes in Patients Undergoing Lung Transplantation

Cited by 10 publications

References 28 publications

Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

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