Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study

Filho, Clóvis T. Bevilacqua; Schmidt, André; Félix, Elaine Aparecida; Bianchi, Fabiana; Guerra, Fernanda M.; Andrade, Cristiano Feijó

doi:10.1016/j.bjane.2021.02.003

Cited by 13 publications

(15 citation statements)

References 30 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This incidence lies within the previously reported PPC rate of 5% to 55% in the literature. 1,3,4,[11][12][13][14][15][16][17] Similar incidence was reported by Bevilacqua et al who found 20% of cases developed PPCs after thoracotomy lung resection with a mortality rate of 5%, and pneumonia was the most common complication. 11 However, our incidence was higher than the results reported by Pipanmekaporn et al who included a total of 1488 patients over a 7-year period, of whom 15.8% developed respiratory complications.…”

supporting

confidence: 83%

The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia

Eldaabossi¹,

Elghoneimy²,

Ghoneim³

et al. 2023

JMDH

View full text Add to dashboard Cite

Background: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results:The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion: ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.

show abstract

supporting

confidence: 83%

The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia

Eldaabossi¹,

Elghoneimy²,

Ghoneim³

et al. 2023

JMDH

View full text Add to dashboard Cite

show abstract

“…( 4) The risk of postoperative pulmonary infection after VATS increases with a prolonged hospital stay. Hospitals are a gathering place for patients with more drug-resistant bacteria and are more prone to lung infections as the hospital stay is prolonged, especially in patients after VATS who have not fully recovered from lung function and have low resistance [17]. The presence of infected patients tends to prolong the hospital stay, thus creating a vicious circle.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for pulmonary infection after thoracoscopic pneumonectomy and the predictive value of laboratory-related indicators

Zhang

Tao

Guan

et al. 2023

Preprint

View full text Add to dashboard Cite

Objective: To investigate the risk factors and the predictive value of laboratory-related indexes for complications of pulmonary infections after lung resection by video-assisted thoracoscopic surgery (VATS). Methods: The clinical data and laboratory test results of 200 patients who underwent VATS lung resection at the Affiliated Hospital of Southwestern Medical University from December 2021 to July 2022 were retrospectively analyzed. Univariate and multifactorial logistic regression were used to analyze whether their gender, age, (American Society of Anesthesiologists) ASA classification, duration of surgery, intraoperative bleeding, days of hospitalization, hypoproteinemia, diabetes mellitus, smoking index, and underlying lung disease were risk factors for postoperative pulmonary infection. The levels of preoperative and early postoperative nutritional parameters (serum albumin, prealbumin) and inflammatory cells (total leukocyte count, neutrophil count, neutrophil ratio) were measured and compared 24 h after surgery. ROC curve analysis of the predictive effect of inflammatory cells on postoperative pulmonary infection. Results: In 200 patients undergoing pulmonary VATS, 42 cases of postoperative pulmonary infection occurred, with an infection rate of 21%. Univariate analysis showed statistically significant differences in gender, age, presence of hypoproteinemia, length of hospital stay, smoking index, presence of underlying pulmonary disease, presence of diabetes mellitus, duration of surgery, intraoperative bleeding, and ASA classification between those with and without postoperative pulmonary VATS (p <0.05). Multifactorial logistic regression analysis showed that the presence of underlying lung disease (OR = 3.065), presence of diabetes (OR = 5.123), duration of surgery (≥120 min) (OR = 4.641), and length of hospital stay >7 days (OR = 7.428) were independent risk factors for pulmonary infection after pulmonary VATS (p<0.05). Preoperative pulmonary infected patients had lower albumin and prealbumin levels than those without pulmonary infection, and higher white blood cell count and neutrophil count than those without pulmonary infection. Pre-albumin was lower in those with postoperative 24 h pulmonary infection than in those without pulmonary infection, and leukocyte count and neutrophil count were higher than in those without pulmonary infection, and the difference was statistically significant (p<0.05). According to the results of the ROC curve, the area under the curve for leukocytes and neutrophils at 24 h postoperatively was 0.684 (95% CI: 0.595-0.773, P<0.001) and 0.675 (95% CI:0.587-0.764, P<0.001), respectively, and the area under the curve for combined inflammatory cells to predict lung infection was 0.702 (95%CI:0.615-0.790, P<0.001). Conclusion: Patients with combined underlying lung disease, diabetes mellitus, operative time >120 min, and length of hospital stay >7 days were independent risk factors for post-thoracoscopic complications of pulmonary infection, and low early nutritional indicators and abnormal laboratory infection indicators were associated with the development of postoperative pulmonary infection. The preoperative and 24 h postoperative levels of inflammatory cells had some predictive value for a lung infection.

show abstract

“…Moreover, a short LOS reduces medical costs and improves bed turnover rate [12]. Furthermore, a prolonged LOS is associated with surgical procedural factors, patient factors, practical protocols, and the development of perioperative complications [13]. Several studies have demonstrated that there is no difference in LOS between patients in TIVA and volatile anesthesia groups [6,7].…”

Section: Discussionmentioning

confidence: 99%

Total intravenous anesthesia shortens hospital stay after lung resection surgery: A propensity score matching study.

Hsu

Cheng

Teng

et al. 2023

Preprint

View full text Add to dashboard Cite

Background There is no consensus regarding the superiority of volatile or total intravenous anesthesia (TIVA) in reducing the incidence of postoperative pulmonary complications (PPCs) after lung resection surgery (LRS). Thus, the aim of this study was to investigate the effects of TIVA and volatile anesthesia on the incidence of PPCs in patients who underwent LRS. We hypothesized that TIVA is associated with a lower incidence of PPCs than volatile anesthesia.Methods This was a retrospective cohort study of patients who underwent LRS at Taipei Veterans General Hospital between January 2016 and December 2020. The patients’ charts were reviewed and data on patient characteristics, perioperative features, and postoperative outcomes were extracted and analyzed. The patients were categorized into TIVA and volatile anesthesia groups and their clinical data were compared. Propensity score matching was performed to reduce potential selection bias. The primary outcome was the difference between the incidence of PPCs in the volatile anesthesia and TIVA groups, whereas the secondary outcomes were the differences in the incidences of other postoperative events, such as length of hospital stay (LOS) and postoperative nausea and vomiting (PONV), between the two groups.Results A total of 396 patients each were included in the TIVA and volatile anesthesia groups. There was no statistically significant difference in the incidence of PPCs between the volatile anesthetic and TIVA groups. The TIVA group had a shorter LOS (p < 0.001) and a lower incidence of PONV than the volatile anesthesia group (4.5% in the TIVA group vs. 8.8% in the volatile anesthesia group; p = 0.016). However, there were no significant differences in reintubation, 30-day readmission, and reoperation rates between the two groups.Conclusions There is no significant difference between the incidence of PPCs in patients who underwent LRS under TIVA and that in patients who underwent LRS under volatile anesthesia. However, TIVA may be a better choice for maintenance of anesthesia in patients undergoing LRS.

show abstract

Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study

Cited by 13 publications

References 30 publications

The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia

The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia

Analysis of risk factors for pulmonary infection after thoracoscopic pneumonectomy and the predictive value of laboratory-related indicators

Total intravenous anesthesia shortens hospital stay after lung resection surgery: A propensity score matching study.

Contact Info

Product

Resources

About