An update on red blood cell transfusion in non-cardiac thoracic surgery

BACKGROUND: The aim of this study was to evaluate risk factors for red blood cell (RBC) transfusion in non-cardiac thoracic surgery. METHODS: All patients undergoing non-cardiac thoracic surgery in a single tertiary referral center between January and December 2021 were eligible for this study. Data on blood requests and perioperative RBC transfusion were retrospectively analyzed. RESULTS: A total of 379 patients were included, of whom 275 (72.6%) underwent elective surgery. The overall RBC transfusion rate was 7.4% (elective cases: 2.5%, non-elective cases: 20.2%). Patients with lung resections required transfusion in 2.4% of the cases versus 44.7% in patients undergoing surgery for empyema. In multivariable analysis, empyema (P=0.001), open surgery (P<0.001), low preoperative hemoglobin (P=0.001), and old age (P=0.013) were independent risk factors for RBC transfusion. The best predictor of blood transfusion was preoperative hemoglobin with a cut-off value <10.4 g/dL (sensitivity 82.1%, specificity 86.3%, area under the curve 0.882). CONCLUSIONS: The rate of RBC transfusion in current non-cardiac thoracic surgery is low, especially in elective lung resections. In urgent cases and open surgery, transfusion rates remain high, particularly in empyema cases. Preoperative requesting of RBC units should be tailored to patient-specific risk factors.