P-170RESPIRATORY FAILURE AFTER PNEUMONECTOMY: THE PRICE OF POSTOPERATIVE TRANSFUSIONS
Bibliographic record
Abstract
Objectives: Transfusion of blood products has been associated with increased risk of post-pneumonectomy respiratory failure. It is unclear whether intra- or postoperative transfusions confer higher risk of respiratory failure. Our objective was to assess the role of transfusions in developing post-pneumonectomy respiratory failure. Methods: We performed a retrospective cohort study using prospectively-collected data on consecutive pneumonectomies (2005-2015). Patient records were reviewed for intra-/postoperative exposures. Univariable and multivariable analyses were performed. Results: Of the 251 pneumonectomies performed during the study period, 24 (9.6%) patients suffered respiratory failure. Ninety-day mortality was 5.6% (n = 14) and was more likely in patients with respiratory failure (7/24 vs 7/227, P < 0.001). Intraoperative and postoperative transfusions occurred in 42.2% (n = 106) and 44.6% (n = 112) of patients respectively and were predominantly red blood cells. On univariable analysis, both intraoperative (P=0.03) and postoperative transfusion (P=0.004) were associated with higher risk for respiratory failure. The multivariable model significantly predicted respiratory failure with an AUC=0.88 (P=0.001). On multivariable analysis, the only independent predictors of respiratory failure were postoperative transfusions (adjusted odds ratio [aOR]=6.54, 95% CI 1.74–24.59, P=0.005) and lower preoperative FEV1 (aOR=0.96, 95% CI 0.93–0.99, P=0.03). Estimated blood loss (EBL) was not significantly different (P=0.91) between those with (median=800 ml, interquartile range 300-2000 ml) and without respiratory failure (median=800 ml, nterquartile range 300-2000 ml). Conclusions: Respiratory failure occurred in 9.6% of patients post-pneumonectomy and confers higher risk of 90-day mortality. Postoperative (but not intraoperative) transfusion was the strongest independent predictor of respiratory failure. EBL is not significantly different between those with and without respiratory failure, thus our findings are not likely due to confounding relationships between increased intraoperative bleeding complications, reactionary transfusions and respiratory failure. Intraoperative transfusion may be in reaction to active/unpredictable blood loss and may not be easily modifiable. However, postoperative transfusion may be modifiable and potentially avoidable. Transfusion thresholds should be assessed in light of potential cost-benefit trade-offs. Disclosure: No significant relationships.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".