Analysis of risk factors and management of unexpected intraoperative bleeding during video-assisted thoracic surgery for non-small cell lung cancer: a case-control study.

Background: Intraoperative bleeding is one of the most dangerous complications of thoracoscopic surgery and seriously endangers the life of patients. How to prevent and manage intraoperative bleeding is a core concern for every thoracic surgeon. The aim of our study was to analyze the related risk factors of unexpected intraoperative bleeding during video-assisted thoracoscopic surgery (VATS) and the strategies for managing bleeding.

Methods: A total of 1,064 patients who underwent anatomical pulmonary resection were analyzed retrospectively. According to the presence or absence of intraoperative bleeding, all cases were divided into an intraoperative bleeding group (IBG) and a reference group (RG). Clinicopathological characteristics and perioperative outcomes were compared in both groups. In addition, the sites, reasons, and coping strategies of intraoperative bleeding were summarized and analyzed.

Results: After rigorous screening, 67 patients with intraoperative bleeding and 997 patients without intraoperative bleeding were included in our study. Compared with the RG, among patients in the IBG, there was a higher incidence of history of chest surgery (P<0.001), higher incidence of pleural adhesion (P=0.015), higher incidence of squamous cell carcinoma (P=0.034), and the fewer early T-stage cases (P=0.003). In the multivariate analyses, a history of chest surgery (P=0.001) and T stage (P=0.010) were independent risk factors of intraoperative bleeding. The IBG was associated with the longer operative time, the more blood loss, the higher rates of intraoperative blood transfusion and conversion, the longer hospital stay and the more complications. There were no significant differences in the duration of chest drainage (P=0.066) between IBG and RG. The most common injury site of intraoperative bleeding was the pulmonary artery (72%). The commonest cause of intraoperative bleeding was the accidental injury of energy device (37%). The most frequently used method for managing intraoperative bleeding was suturing of the bleeding site (64%).

Conclusions: Although unexpected intraoperative bleeding during VATS is unavoidable, it can be controlled provided that positive and effective hemostasis are achieved. However, prevention is the priority.