Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy
Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures. A single-center, retrospectiv...
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| Veröffentlicht in: | The Journal of surgical research 2020-11, Vol.255, p.411-419 |
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| creator | Azizgolshani, Nasim M. Porter, Eleah D. Fay, Kayla A. Dunbar, Nancy M. Hasson, Rian M. Millington, Timothy M. Finley, David J. Phillips, Joseph D. |
| description | Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures.
A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules.
Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P |
| doi_str_mv | 10.1016/j.jss.2020.05.087 |
| format | Article |
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A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules.
Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year.
Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2020.05.087</identifier><identifier>PMID: 32619855</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Anatomic lung resection ; Blood Transfusion - statistics & numerical data ; Esophagectomy ; Esophagectomy - statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Preoperative Care ; Preoperative type and screen ; Pulmonary Surgical Procedures - statistics & numerical data ; Retrospective Studies ; Thoracic surgery ; Transfusion ; Unnecessary Procedures</subject><ispartof>The Journal of surgical research, 2020-11, Vol.255, p.411-419</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-e932d972ff352a317c4a00217c044111c4537676ecac7e80d28342f042fc31873</citedby><cites>FETCH-LOGICAL-c409t-e932d972ff352a317c4a00217c044111c4537676ecac7e80d28342f042fc31873</cites><orcidid>0000-0001-8601-5438 ; 0000-0002-8663-0251 ; 0000-0001-9309-7726</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480420303632$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32619855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azizgolshani, Nasim M.</creatorcontrib><creatorcontrib>Porter, Eleah D.</creatorcontrib><creatorcontrib>Fay, Kayla A.</creatorcontrib><creatorcontrib>Dunbar, Nancy M.</creatorcontrib><creatorcontrib>Hasson, Rian M.</creatorcontrib><creatorcontrib>Millington, Timothy M.</creatorcontrib><creatorcontrib>Finley, David J.</creatorcontrib><creatorcontrib>Phillips, Joseph D.</creatorcontrib><title>Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures.
A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules.
Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year.
Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.</description><subject>Aged</subject><subject>Anatomic lung resection</subject><subject>Blood Transfusion - statistics & numerical data</subject><subject>Esophagectomy</subject><subject>Esophagectomy - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Preoperative Care</subject><subject>Preoperative type and screen</subject><subject>Pulmonary Surgical Procedures - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Thoracic surgery</subject><subject>Transfusion</subject><subject>Unnecessary Procedures</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1DAQtRCILoUfwAX5yCXp-CNxIg6oqhaotBKoH2fLOJOtV4kd7OxK--_r3S0VvXCwRp558-bpPUI-MigZsPpiU25SKjlwKKEqoVGvyIJBWxVNrcRrsgDgvJANyDPyLqUN5H-rxFtyJnjN2qaqFsT8ihgmjGZ2O6R3-wmp8R29tRHRU5fovfdoMSUT99R5uhzQHqGX3sxhdJautn5NbzAd-sEft5cpTA9mnTth3L8nb3ozJPzwVM_J_bfl3dWPYvXz-_XV5aqwEtq5wFbwrlW870XFjWDKSpP15gpSMsasrISqVY3WWIUNdLwRkveQnxWsUeKcfD3xTtvfI3YW_RzNoKfoxqxdB-P0y4l3D3oddpqBqrJRbWb4_MQQw58tplmPLlkcBuMxbJPmkgOTDReHY-wEtTGkFLF_vsNAH7LRG52z0YdsNFQajgI__SvweeNvGBnw5QTAbNPOYdTJOvQWOxezl7oL7j_0j3DXoCM</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Azizgolshani, Nasim M.</creator><creator>Porter, Eleah D.</creator><creator>Fay, Kayla A.</creator><creator>Dunbar, Nancy M.</creator><creator>Hasson, Rian M.</creator><creator>Millington, Timothy M.</creator><creator>Finley, David J.</creator><creator>Phillips, Joseph D.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8601-5438</orcidid><orcidid>https://orcid.org/0000-0002-8663-0251</orcidid><orcidid>https://orcid.org/0000-0001-9309-7726</orcidid></search><sort><creationdate>20201101</creationdate><title>Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy</title><author>Azizgolshani, Nasim M. ; Porter, Eleah D. ; Fay, Kayla A. ; Dunbar, Nancy M. ; Hasson, Rian M. ; Millington, Timothy M. ; Finley, David J. ; Phillips, Joseph D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-e932d972ff352a317c4a00217c044111c4537676ecac7e80d28342f042fc31873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Anatomic lung resection</topic><topic>Blood Transfusion - statistics & numerical data</topic><topic>Esophagectomy</topic><topic>Esophagectomy - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Preoperative Care</topic><topic>Preoperative type and screen</topic><topic>Pulmonary Surgical Procedures - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Thoracic surgery</topic><topic>Transfusion</topic><topic>Unnecessary Procedures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azizgolshani, Nasim M.</creatorcontrib><creatorcontrib>Porter, Eleah D.</creatorcontrib><creatorcontrib>Fay, Kayla A.</creatorcontrib><creatorcontrib>Dunbar, Nancy M.</creatorcontrib><creatorcontrib>Hasson, Rian M.</creatorcontrib><creatorcontrib>Millington, Timothy M.</creatorcontrib><creatorcontrib>Finley, David J.</creatorcontrib><creatorcontrib>Phillips, Joseph D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azizgolshani, Nasim M.</au><au>Porter, Eleah D.</au><au>Fay, Kayla A.</au><au>Dunbar, Nancy M.</au><au>Hasson, Rian M.</au><au>Millington, Timothy M.</au><au>Finley, David J.</au><au>Phillips, Joseph D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2020-11-01</date><risdate>2020</risdate><volume>255</volume><spage>411</spage><epage>419</epage><pages>411-419</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures.
A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules.
Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year.
Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32619855</pmid><doi>10.1016/j.jss.2020.05.087</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8601-5438</orcidid><orcidid>https://orcid.org/0000-0002-8663-0251</orcidid><orcidid>https://orcid.org/0000-0001-9309-7726</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aged Anatomic lung resection Blood Transfusion - statistics & numerical data Esophagectomy Esophagectomy - statistics & numerical data Female Humans Male Middle Aged Preoperative Care Preoperative type and screen Pulmonary Surgical Procedures - statistics & numerical data Retrospective Studies Thoracic surgery Transfusion Unnecessary Procedures |
| title | Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy |
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