Evaluation of Factors Affecting the Development of Re-Operation Due to Hemorrhage After Lung Resection

Abstract

In our study, peroperative factors affecting the development of re-operation after lung resection were examined.413 patients who underwent lung resection between 2018-2020 were included in our study. The peroperative data of 25 (6.1%) patients who underwent re-operation and 388 (93.9%) patients who did not undergo re-operation were compared. Preoperative hemoglobin level (p=0.009), neoadjuvant therapy (p<0.001), pneumonectomy (p<0.001), thoracotomy (p=0.005), amount of intraoperative blood loss (p<0.001), need for intraoperative blood product use (p). =0.005), intraoperative mean arterial pressure (p=0.01), pulse rate (p=0.001), postoperative hemoglobulin amount (p<0.001) were found to affect and increase the probability of re-operation. It was statistically significant that the need for postoperative blood product usage was higher (p<0.001), postoperative complications (100% vs. 22.8%, p<0.001) and mortality (0.6% vs. 4%, p=0.01) in reoperated patients. It was found that the hospitalization day in the ICU was longer in those who underwent reoperation than in those who did not (3.2 days vs. 1.5, p<0.001). Independent risk factors affecting re-operation according to multiple logistic regression analysis; neoadjuvant treatment (p<0.001), operation time (p=0.04), intraoperative pulse rate (p=0.01) and postoperative hemoglobin (p<0.001) were found. Low preoperative hemoglobin level, on the other hand, independently affected the development of re-operation at a level close to significance (p=0.06). Re-operation due to bleeding after lung resection increases the rate of cardiopulmonary complications in the postoperative period. Careful follow-up and approach of surgery and anesthesia in the intraoperative period will contribute to the decrease in the incidence of re-operation.

Keywords

• Re-operation
• Hemorrhage
• Thoracic Surgery
• Lung Resection

References

1. 1) Sayar A, Metin M, Ölçmen A. et al. Postoperative Haemorrage Which Causes Rethoracotomy: Etiology, Treatment and Prognosis. GKDC journal. 1998; 6: 342-346 .
2. 2) Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Hatachi G, Kitamura Y, Obata T, Doi R, Machino R, Nagayasu T. Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience. Surg Today. 2016 Aug;46(8):901-7.
3. 3) Karapınar K, Erdogan S, Sezen CB, Kutluk AC, Aker C, Kalafat CE, Bilen S, Kocaturk CI. 2018, Distribution of MEFV Gene Mutations and Allele Frequencies in Patients with Familial Mediterranean Fever - One Center Experience, Osmangazi Tıp Dergisi, 40 (2): 33-38.
4. 4) Uramoto H, Shimokawa H, Tanaka F. Postoperative bleeding after surgery in patients with lung cancer. Anticancer Res. 2014 Feb;34(2):981-4.
5. 5) Litle VR, Swanson SJ. Postoperative bleeding: coagulopathy, bleeding, hemothorax. Thorac Surg Clin. 2006 Aug;16(3):203-7.
6. 6) Nakamura H, Saji H, Kurimoto N, Shinmyo T, Tagaya R. Impact of intraoperative blood loss on long-term survival after lung cancer resection. Ann Thorac Cardiovasc Surg. 2015;21(1):18-23.
7. 7) Decaluwe H, Petersen RH, Hansen H, Piwkowski C, Augustin F, Brunelli A, Schmid T, Papagiannopoulos K, Moons J, Gossot D; ESTS Minimally Invasive Thoracic Surgery Interest Group (MITIG). Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis. Eur J Cardiothorac Surg. 2015 Oct;48(4):588-98.
8. 8) Erdoğu V, Selin Onay M, Çiftçi A, Yasemin Emetli E, Erduhan S, Pekçolaklar A, Vedat Doğru M, Aksoy Y, Cevat Kutluk A, Metin M. Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage. Curr Thorac Surg. 2021; 6(2): 051-057.

9. 9) Harpole DH Jr, DeCamp MM Jr, Daley J, Hur K, Oprian CA, Henderson WG et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Car¬diovasc Surg 1999; 117: 969-79.
10. 10) Gupta R, Fuks D, Bourdeaux C, Radkani P, Nomi T, Lamer C, Gayet B. Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection. Surg Endosc. 2017 Nov;31(11):4451-4457.
11. 11) Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc. 2006 Apr;38(3):812-4.
12. 12) Yano M, Numanami H, Akiyama T, Taguchi R, Furuta C, Haniuda M. Reoperation for postoperative bleeding following pulmonary resection: a report of a single-center experience. Gen Thorac Cardiovasc Surg. 2019 Jul;67(7):608-614.
13. 13) Li S, Zhou K, Lai Y, Shen C, Wu Y, Che G. 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. BMC Surg. 2018 May 23;18(1):29.
14. 14) Li Q, Zhang X, Xu M, Wu J. A retrospective analysis of 62,571 cases of perioperative adverse events in thoracic surgery at a tertiary care teaching hospital in a developing country. J Cardiothorac Surg. 2019 May 31;14(1):98.
15. 15) Fu D, Wu C, Li X, Chen J. Elevated preoperative heart rate associated with increased risk of cardiopulmonary complications after resection for lung cancer. BMC Anesthesiol. 2018 Jul 25;18(1):94.
16. 16) Brady K, Hogue CW. Intraoperative hypotension and patient outcome: does "one size fit all?". Anesthesiology. 2013 Sep;119(3):495-7.
17. 17) Kinnunen EM, Juvonen T, Airaksinen KE, Heikkinen J, Kettunen U, Mariscalco G, Biancari F. Clinical significance and determinants of the universal definition of perioperative bleeding classification in patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1640-1646.
18. 18) Thomas P, Michelet P, Barlesi F, Thirion X, Doddoli C, Giudicelli R, Fuentes P. Impact of blood transfusions on outcome after pneumonectomy for thoracic malignancies. Eur Respir J. 2007 Mar;29(3):565-70.
19. 19) Yao L, Wang W. Effect of intraoperative blood loss on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Jul 26;29(3):347-353.