Association Between Early Postoperative Hypoxia and Postoperative Pulmonary Complications in Lung Resection Surgery: A Retrospective Cohort Study

Introduction Despite extensive research has explored the predictive role of preoperative and intraoperative pulse oxygen saturation (SpO 2 ) levels in postoperative pulmonary complications (PPCs), relatively little attention has been given to the association between early postoperative SpO 2 and PPCs. Patients undergoing lung resection surgery often experience early postoperative hypoxia. This study aimed to assess whether early postoperative hypoxia predicts PPCs after lung resection surgery. Materials and methods This retrospective cohort study analyzed data from the electronic medical records of patients who underwent elective lung resection surgery with one-lung ventilation from January 2020 to December 2023. Early postoperative hypoxia was defined as an SpO 2 < 92% in conscious, extubated patients breathing room air for at least 5 min in the postanesthesia care unit. Multivariate logistic regression and modified Poisson regression analyses were performed to examine the association between early postoperative hypoxia and PPCs occurring within the first seven postoperative days. Results A total of 1147 patients were analyzed. Of these, 156 patients (13.6%) developed PPCs, and 212 patients (18.5%) experienced early postoperative hypoxia. Multivariate logistic regression analysis revealed that early postoperative hypoxia was independently associated with an increased incidence of PPCs (odds ratio 5.39; 95% confidence interval [CI], 3.69-7.92; P < 0.001). The sensitivity and specificity of early postoperative hypoxia for predicting PPCs were 0.86 (95% CI, 0.84–0.89) and 0.51 (95% CI, 0.42-0.57), respectively. Modified Poisson regression analysis further confirmed that early postoperative hypoxia significantly increased PPCs risk (relative risk 4.30; 95% CI, 3.26-5.67; P < 0.001). Conclusions Early postoperative hypoxia is common among patients undergoing lung resection surgery and significantly increases the risk of developing PPCs.