Excessive intravenous crystalloid infusion after video-assisted thoracoscopic surgery lobectomy is associated with postoperative pneumonia

Abstract

BackgroundVideo-assisted thoracoscopic surgery has been widely used in thoracic surgery worldwide. Our goal was to identify the risk factors for postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery lobectomy.MethodsA retrospective analysis of adult patients undergoing video-assisted thoracoscopic surgery lobectomy between 2016 and 05 and 2017–04 was performed. We used univariate analyses and multivariate analyses to examine risk factors for postoperative pneumonia after lobectomy.ResultsThe incidence of postoperative pneumonia was 19.7% (n = 143/727). Patients with postoperative pneumonia had a higher postoperative length of stay and total hospital care costs when compared to those without postoperative pneumonia. Multivariate analysis showed that body mass index grading ≥24.0 kg/m2 (vs. <24.0 kg/m2: odds ratio 1.904, 95% confidence interval 1.294–2.802, P = 0.001) and right lung lobe surgery (vs. left lung lobe surgery: odds ratio 1.836, 95% confidence interval 1.216–2.771, P = 0.004) were independent risk factors of postoperative pneumonia. Total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL was also identified as the risk factors (vs. 1000 to < 1500 mL: odds ratio 2.060, 95% confidence interval 1.302–3.260, P = 0.002).ConclusionsMajor risk factors for postoperative pneumonia following video-assisted thoracoscopic surgery lobectomy are body mass index grading ≥24.0 kg/m2, right lung lobe surgery and total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL.

Safety, efficacy, and analysis of key parameters after prophylactic administration of a sustained-release formulation of azithromycin in lung cancer surgery

“…However, some technical issues were involved in 3 cases, suggesting that this AZM formulation was not inferior to classical prophylactic treatment. A significant relationship was only observed between postoperative pneumonia and heart disease as a comorbidity, which was consistent with previous reports that showed underlying heart disease as a risk factor for postoperative pneumonia (31,33). Although direct correlation between AZM and postoperative pneumonia was not found, the high concentration of AZM in the lung may prevent postoperative pneumonia through an anti-inflammatory effect, as evidenced by the low IL-6 expression in this study.…”

“…Postoperative pneumonia is one of the most common complications in patients with lung cancer undergoing therapeutic surgical resection and has been reported as a poor prognostic factor (29,30). The reported incidence of postoperative pneumonia following lung cancer surgery ranges from 3.6% to 18.7% (29)(30)(31)(32). The incidence of postoperative pneumonia in our study was 10% (5 cases), while that with traditional cephem antibiotics in our institution was 6.7% to 9.4% between 2013 and 2015 (data not shown).…”

An External-Validated Algorithm to Predict Postoperative Pneumonia Among Elderly Patients With Lung Cancer After Video-Assisted Thoracoscopic Surgery

“…Our study found that 9.15% (145/1,585) of patients suffered from postoperative pneumonia in the Thoracic Perioperative Database for Geriatrics, and 10.30% (17/165) of patients had postoperative pneumonia in the external validation dataset, and these numbers were consistent with other studies. Other studies reported that the prevalence of postoperative pneumonia was 3.6% ( 21 ) to 19.7% ( 15 ). This variation possibly could be explained by the population heterogeneity: the variety of age, different procedures, and diverse inclusive criteria.…”

“…Several studies have pointed out that some variables were associated with postoperative pneumonia among lung cancer patients after surgery ( 14 , 15 , 22 – 33 ). More explicitly, in 2015, Simonsen et al.…”

“…A prospective observational study reported that the rate of postoperative pulmonary complication could be 7.40% ( 13 ) and it is related to longer hospitalization, higher frequency of intensive therapy unit admission, and higher hospital mortality ( 14 ). Moreover, the incidence of postoperative pneumonia could be as high as 19.7% after video-assisted thoracoscopic surgery among lung cancer patients ( 15 ). Thus, identification and modification of risk factors associated with postoperative pneumonia could be very beneficial to predict and subsequently prevent the complication in advance.…”