Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study

Abstract

Purpose Perioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients. Methods We performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adjust for multiple interactions, the false discovery rate (Q value) was utilized to appropriately adjust P values and a Q value \ 0.05 was considered to be significant.

Perioperative Management of Patients with Idiopathic Pulmonary Fibrosis Undergoing Noncardiac Surgery: A Narrative Review

“…62 Further supporting this observation, McDowell et al found an 5% incidence of AE-ILD in IPF populations with no significant difference between non-thoracic and thoracic study cohorts [N = 4 (thoracic) vs 6 (non-thoracic) RR: 1.16 (CI: 0.34 to 0.99 Q = 4.0). 22 Similarly, Takao et al found an incidence of 6.3% and mortality rate of 80% of AE-ILD in a cohort of all-ILD patients after non-pulmonary surgery. 37 …”

“… 4 Another study demonstrated a correlation between preoperative home oxygen use and postoperative ARW in IPF patients, providing an easy identifier of higher-risk IPF patients (Relative Risk 2.70; 95% CI: 1.50, 4.86, P < 0.001). 22 Furthermore, IPF patients with <80% FVC on preoperative pulmonary function testing have been found to have increased cardiopulmonary complications and worse long-term survival after lung resection. 23 , 24 …”

“… 42 In an IPF-specific population, increasing surgical time was an independent risk factor for postoperative ARW (Relative Risk 1.03; 95% CI: 1.02, 1.05, P < 0.001). 22 Long periods of mechanical ventilation, likely associated with ventilator-associated lung injury, are detrimental in IPF patients. This is supported by data from a large non-surgical IPF study cohort, where higher in-hospital mortality was found with mechanical ventilation [OR 4.65 (95% CI 3.73,5.80)], admission to the intensive care unit [OR 1.83 (95% CI 1.52, 2.21)] and concurrent pneumonia [OR 1.44 (95% CI 1.21, 1.71)].…”

“… 42 , 74 Following noncardiac surgery in IPF patients, McDowell et al identified an 9.2% risk for 30-day postoperative pneumonia. 22 Nonsurgical, or spontaneous, pneumothorax is another common complication associated with advanced IPF, with an incidence of 11%. 75 Spontaneous pneumothorax in patients with IPF has a poor prognosis, is often refractory to treatment with thoracostomy tube placement and often requires surgical pleurodesis.…”

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“…For instance, cardiovascular conditions may include those such as unstable angina, congestive heart failure, previous stroke, or myocardial infarction within the last 3 months [9]. Patients with respiratory-related conditions such as chronic obstructive pulmonary disease or pulmonary fibrosis requiring oxygen supplementation may also be at higher perioperative risk [10]. Other conditions include history of poor wound healing due to poorly controlled diabetes or morbid obesity, resulting in a high anaesthetic risk.…”