A Delphi consensus report of the Italian society of thoracic surgery on influencing factors, use of a bleeding scale, and management of bleeding in thoracic surgery

Introduction: We report the results of a national consensus paper among Italian thoracic surgeons obtained through a Delphi process, on the bleeding in thoracic surgery (BTS) evaluating influencing factors, use of a validated intraoperative bleeding scale (VIBeS), its management and helping improving practice. Methods: A panel of 20 statements (a total of 39 issues) was developed and, after initial validation by six experts, was electronically sent to 60 Italian thoracic surgeons. Participants were asked to score each statement on a 5-point Likert scale and the agreement was scored for evaluating the consensus (>66%). Results: Overall, a total of 49 (82%) participants scored the proposed statements. The consensus was reached in 35/39 issues (89.7%). Responders agreed (>90%) that medical (comorbidities, anticoagulant or antiplatelet therapies) and surgical factors (pleural adhesions, procedures on parietal pleura and chest wall resection) influenced BTS. Use of VIBeS has gained broad positive acceptance (>90%). Effects of BTS have achieved a broad positive consensus both for intraoperative and post-operative ones (surgeon stress, overall costs, length of operation, postoperative complications) (>73%). Modality of reduction and management of BTS (use of appropriate hemostatic products according to the coagulation status and VIBeS) has obtained a broad positive consensus. Conclusions: The expert panel of Italian thoracic surgeons reached an agreement on the majority of issues of Delphi survey (factors, effects and management of BTS). The use of a VIBeS is recommended. In the absence of prospective and randomized studies on management of BTS, this document may be useful for reducing practice variation among thoracic surgeons facing intraoperative bleeding.