Perioperative transfusion rates and efficiency in thoracic surgery: toward rational transfusion strategies

Objective: To evaluate perioperative blood transfusion requirements, transfusion-related risk factors, and blood utilization efficiency in thoracic surgery, and to establish procedure-specific recommendations for the Maximum Surgical Blood Ordering Schedule (MSBOS). Materials and Methods: A retrospective analysis was conducted on 2,062 patients who underwent thoracic surgery at a single center between January 2022 and June 2024. Demographic characteristics, comorbidities, surgical techniques, perioperative transfusion requirements, and clinical outcomes were analyzed. Transfusion efficiency was assessed using the Transfusion Index (TI), Transfusion Percentage (%T), and Crossmatch-to-Transfusion Ratio (C/T). MSBOS recommendations were derived based on these metrics. Results: Perioperative transfusion was required in 15.1% of patients, while 8.0% received intraoperative transfusions. Transfusion need was significantly associated with advanced age, lower preoperative hemoglobin levels, longer anesthesia duration, thoracotomy, decortication, and pneumonectomy. Patients who received intraoperative transfusions had significantly higher complication and mortality rates. Overall transfusion efficiency was low (TI: 0.27; %T: 15%), indicating substantial over-preparation of blood products. Conclusion: Routine preoperative blood preparation is unnecessary for many thoracic surgery procedures. A procedure-specific MSBOS or a “type-and-screen” strategy appears sufficient for most interventions, except for decortication and pneumonectomy. Tailored patient blood management strategies, including procedure-specific MSBOS implementation, may substantially improve resource utilization and patient outcomes.