title: Impact of blood transfusions on outcome after pneumonectomy for thoracic malignancies.
abstract: The aim of the present study was to determine the risk factors and impact on outcome of blood transfusions following pneumonectomy for thoracic malignancies. A retrospective analysis of 432 consecutive patients was carried out, of whom 183 (42.4%) were transfused post-operatively. 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. It was found that 30-day mortality increased significantly from 2.4% (no transfusion) to 10.9 and 21.9% (<or=2 and >2 red blood cell packs, respectively). Blood transfusion was the strongest predictor of 30-day mortality (odds ratio (OR) 10; 95% confidence interval (CI): 3.7-27), respiratory failure (OR 19.2; 95% CI 7.4-49.4) and infectious complications (OR 3; 95% CI 1.5-6.2). In the 367 lung cancer patients, a significantly lower 5-yr survival was observed in univariate analysis of transfused patients (27.8+/-5.4% versus 39.4+/-4.5%). In a Cox regression analysis, blood transfusion was no longer found to be 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.
authors.affiliation: Faculty of Medicine, Université de la Méditerranée, Marseille, France. Pascal-alexandre.Thomas@mail.ap-hm.fr
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Michelet
authors.forename: F
authors.initials: F
authors.lastname: Barlesi
authors.forename: X
authors.initials: X
authors.lastname: Thirion
authors.forename: C
authors.initials: C
authors.lastname: Doddoli
authors.forename: R
authors.initials: R
authors.lastname: Giudicelli
authors.forename: P
authors.initials: P
authors.lastname: Fuentes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000401:mortality; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011013:Pneumonectomy; D011182:Postoperative Care; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013908:Thoracotomy; D065227:Transfusion Reaction