Preoperative Type and Screen Before General Thoracic Surgery: A Nomogram to Reduce Unnecessary Tests

Area of Science:

• Anesthesiology
• Transfusion Medicine
• Thoracic Surgery

Background:

• Preoperative type and screen (T&S) is standard practice before noncardiac thoracic surgery, despite rare intraoperative transfusions.
• This routine practice is considered overly cautious and costly.

Purpose of the Study:

• To evaluate the necessity of routine preoperative type and screen (T&S) in major thoracic surgery.
• To develop and validate a predictive nomogram for identifying patients requiring intraoperative transfusion.

Main Methods:

• A retrospective cohort study of 6280 adult patients undergoing major thoracic surgery from 2007-2016.
• Development of a logistic regression nomogram using a derivation dataset (n=4196) to predict transfusion likelihood.
• Validation of the nomogram for discrimination, calibration, and negative predictive value.

Main Results:

• Only 7.1% of patients received intraoperative transfusions, despite 46.1% having a preoperative T&S.
• Patients with T&S had lower baseline hemoglobin and were less likely to undergo minimally invasive surgery.
• The nomogram, incorporating age, operation type, approach, BMI, and hemoglobin, achieved 86% c-statistic and 97.9% negative predictive value.

Conclusions:

• Intraoperative blood transfusion is infrequent in major thoracic surgery.
• Patients not undergoing preoperative T&S but requiring transfusion did not experience worse outcomes.
• A predictive nomogram can guide selective T&S ordering, optimizing resource utilization.