Indian Journal of Clinical Anaesthesia


A retrospective analysis of intraoperative blood transfusion practices in patients undergoing thoracotomy and major lung surgery in an Indian tertiary care hospital and formulation of a maximum surgic


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Author Details: Prachi Kar, Shibani Padhy, R. Gopinath

Volume : 4

Issue : 1

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 84

Article End Page : 87


Abstract

Background and Aims: The risk of blood loss in lung surgeries is significant and depends on the nature of surgery. The literature on the pattern of intraoperative requirement of blood transfusion in various types of lung surgeries is scarce. In the absence of clear evidence, often inappropriate amount of blood is cross matched, ordered and transfused. Excessive cross matching of blood can increase the burden on the blood bank. The aim of the study was to analyze the blood transfusion practice in patients undergoing major lung surgery at our center and propose a maximum blood ordering schedule (MSBOS) for optimizing blood ordering.
Methods: Retrospective review of electronic database of medical records and anesthesia charts was done for patients who underwent thoracotomy and major lung surgery between July 2014 and June 2016. All the patients were studied under 5 surgical categories. Upper lobectomy, lower lobectomy, pneumonectomy, decortication and others (Hydatid cyst excision/lung abscess drainage/ Bullectomy/wedge resection). Under each category amount of blood cross matched and transfused intraoperatively were noted. Cross match to transfusion ratio(C: T ratio), Transfusion probability (T%), and Transfusion Index(TI) were calculated and Maximum surgical blood ordering schedule (MSBOS) was proposed in each surgical category.
Results: A total of 229 patients with mean age of 40 years were studied. Four hundred seventy eight units of blood were cross matched and 162 units were transfused in 90 patients. C:T ratio, TI and T% were 2.95, 0.7 and 39% respectively in the total cohort. All the three indices showed significant usage of blood in upper lobectomy and pneumonectomy group whereas all the indices showed low requirement of blood in patients undergoing decortication, Bullectomy, hydatid cyst excision, lung abscess drainage and wedge resection. MSBOS suggested crossmatch and reserve of 2 blood units for upper lobectomy and pneumonectomy, and 1unit for lower lobectomy. Decortication, Bullectomy, hydatid cyst excision, lung abscess drainage and wedge resection were suitable for Type and Screen (T&S)
Conclusion: Blood ordering based on surgical category can provide a rational and efficient way of blood ordering and management of resources in patients undergoing lung surgeries.

Keywords:
Maximum surgical blood ordering schedule(MSBOS), Lung surgeries, Transfusion