Impact of blood transfusions on outcome after pneumonectomy for thoracic malignancies

¹ Depts of Thoracic Surgery
² Anaesthesia & Intensive Care
³ Thoracic Oncology
⁴ Medical Information & Statistics, Sainte Marguerite Hospital, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, & Assistance Publique -Hôpitaux de Marseille, Marseille, France

^* To whom correspondence should be addressed. E-mail: Pascal-alexandre.Thomas{at}mail.ap-hm.fr.

	Abstract

To determine the risk factors and impact on outcome of blood transfusions following pneumonectomy for thoracic malignancies.

Retrospective analysis of 432 consecutive patients of whom 183 (42.4%) were transfused postoperatively. The associations between blood transfusions and 20 variables were assessed by univariate and multivariate analysis. Survival analysis included log-rank test and Cox regression model.

Patient age, neoadjuvant treatment, completion pneumonectomy, and extended procedures were independent predictors of transfusion. 30-day mortality increased significantly from 2.4% (no transfusion), to 10.9% (2 blood red cells packs) and 21.9% (>2 blood red cells packs). Blood transfusion was the strongest predictor of 30-day mortality (OR:10; 95% interval confidence: 3.7-27; P<10-4), respiratory failure (OR: 19.2; 95% interval confidence: 7.4-49.4; P<10-4), and infectious complications (OR: 3; 95% confidence interval: 1.5-6.2; P=0.003). In the 367 lung cancer patients, a significantly lower 5-year survival was observed at univariate analysis in transfused patients (27.8%±5.4 vs. 39.4%±4.5; P=0.03). At Cox regression analysis, blood transfusion was no longer significant.

A dose-related correlation is suggested between blood transfusion and early mortality through an increase of infectious and respiratory complications. In contrast, blood transfusion had no independent adverse impact on long-term survival.

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