Key result
Postoperative pulmonary complications occurred in 33.1% of patients undergoing thoracotomy for lung cancer, with in-hospital mortality significantly increasing to 7% with two PPCs and 33% with ≥3 PPCs.
Why the study?
Postoperative pulmonary complications are the most frequent complications after lung surgery and increase postoperative mortality, prompting investigation into their incidence, associated in-hospital mortality, and risk factors in patients undergoing open thoracotomy lung resections.
What are the risk factors for postoperative pulmonary complications and in-hospital mortality in patients undergoing open thoracotomy for primary lung cancer?
Cohort (n=1,426)
Yes
What are the risk factors for postoperative pulmonary complications and in-hospital mortality in patients undergoing open thoracotomy for primary lung cancer?
Postoperative pulmonary complications significantly increase in-hospital mortality after open thoracotomy for lung cancer, with risk factors including age, smoking, prolonged surgery, and specific perioperative management strategies.
May inform risk stratification for thoracotomy patients; leaves open prospective trials to test modifiable factors.
Postoperative pulmonary complications (PPCs) represent the most frequent complications after lung surgery, and they increase postoperative mortality. This study investigated the incidence of PPCs, in-hospital mortality rate, and risk factors leading to PPCs in patients undergoing open thoracotomy lung resections (OTLRs) for primary lung cancer. The data from 1426 patients in this multicentre retrospective study were extracted from the German Thorax Registry and presented after univariate and multivariate statistical processing. A total of 472 patients showed at least one PPC. The presence of two PPCs was associated with a significantly increased mortality rate of 7% (p < 0.001) compared to that of patients without or with a single PPC. Three or more PPCs increased the mortality rate to 33% (p < 0.001). Multivariate stepwise logistic regression analysis revealed male gender (OR 1.4), age > 60 years (OR 1.8), and current or previous smoking (OR 1.6), while the pre-operative risk factors were still CRP levels > 3 mg/dl (OR 1.7) and FEV1 < 60% (OR 1.4). Procedural independent risk factors for PPCs were: duration of surgery exceeding 195 min (OR 1.6), the amount of intraoperative blood loss (OR 1.6), partial ligation of the pulmonary artery (OR 1.5), continuing invasive ventilation after surgery (OR 2.9), and infusion of intraoperative crystalloids exceeding 6 mL/kg/h (OR 1.9). The incidence of PPCs was significantly lower in patients with continuous epidural or paravertebral analgesia (OR 0.7). Optimising perioperative management by implementing continuous neuroaxial techniques and optimised fluid therapy may reduce the incidence of PPCs and associated mortality.
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Baar et al. (2022) conducted a cohort in Primary lung cancer (n=1,426). Multiple clinical and procedural risk factors vs. Absence of risk factors was evaluated on At least one postoperative pulmonary complication (PPC). Postoperative pulmonary complications occurred in 33.1% of patients undergoing thoracotomy for lung cancer, with in-hospital mortality significantly increasing to 7% with two PPCs and 33% with ≥3 PPCs.
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