Prognostic models of thirty-day mortality and morbidity after major pulmonary resection

Harpole, David H.; DeCamp, Malcolm M.; Daley, Jennifer; Hur, Kwan; Oprian, Charles A.; Henderson, William G.; Khuri, Shukri F.

doi:10.1016/s0022-5223(99)70378-8

Cited by 256 publications

(24 citation statements)

References 21 publications

(24 reference statements)

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“…The incidence of postoperative bleeding after lobectomy requiring at least 4 units of packed red blood cells was found to be 2.9% [45]. If the patient drains greater than 1L in 1 hour or 200mL/hr for 4 hours coagulation labs need to be checked, and, if normal, reexploration is indicated.…”

Section: Hemorrhagementioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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Section: Hemorrhagementioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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“…The European Society of Thoracic surgeons (ESTS) risk model had 3426 patients with 66 deaths and the Veterans Affairs risk model had 3516 patients with 184 deaths [34,35]. More recently, the French Society of Thoracic and Cardiovascular Surgery [36] and the STS have produced risk-adjustment models to identify predictors of mortality and major complications after lung resections [37], based on databases including .15 000 patients each.…”

Section: Assessment Of the Risk For Surgerymentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

European Respiratory Review

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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“…Such complications include pneumonia, unplanned reintubation, and mechanical ventilation for > 48 hr postoperatively. 1 A meta-analysis of 65 randomized trials suggests that epidural anesthesia with local anesthetics decreases the likelihood of pulmonary infection [risk ratio (RR) 0.36; 95% confidence interval (CI) 0.21-0.65] and pulmonary complications (RR 0.58; 95% CI 0.42-0.80) following major thoraco-abdominal procedures. 2 The use of epidural local anesthetics following thoracotomy may, however, be associated with sympathetic blockade and hypotension.…”

Section: Conclusion : L'ajout D'adrénaline N'a Pas Influencé La Consomentioning

confidence: 99%

“…This study was conducted at the General Campus of the Ottawa Hospital between September 1 2004 and June 1,2006. Following approval of the Ottawa Hospital Research Ethics Board all patients aged 18-75 yr of ASA physical status classification I-III, scheduled to undergo thoracotomy for pneumonectomy, lobectomy, or wedge resection were screened.…”

Section: Study Populationmentioning

confidence: 99%

The addition of adrenaline to thoracic epidural meperidine does not improve analgesia following thoracotomy

Bryson

Thompson

Gagne

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Patient-controlled epidural analgesia (PCEA) with meperidine provides effective analgesia following thoracotomy. Accumulation of normeperidine, a meperidine metabolite with neuroexcitatory effects, has led to recommendations to limit the use of meperidine postoperatively. The purpose of this study was to determine if the addition of adrenaline to PCEA meperidine decreased meperidine consumption, reduced serum normeperidine levels, and improved analgesia following thoracotomy.Methods: Following Research Ethics approval consenting patients were randomly assigned to PCEA with either meperidine (2 mg·mL -1 ) + adrenaline (2 µg·mL -1 ) or meperidine alone (2 mg·mL -1 ). All patients received a standardized anesthetic and similar perioperative care. Visual analogue pain scores (at rest and with activity), quality of recovery (QoR) scores, and side effects were documented six, 24, and 48 hr postoperatively. Serum levels of meperidine and normeperidine were measured at the same time points.Results: Forty-six patients completed the study protocol. Meperidine consumption (mean ± SD) was similar in the meperidine + adrenaline and the meperidine groups (601 ± 211 mg vs 580 ± 211 mg over 48 hr, respectively; P = 0.744). Serum meperidine levels were similar at all study time points. Serum normeperidine was not detected in any sample. Pain scores, QoR scores, and adverse events were comparable in both study groups. Conclusion:The addition of adrenaline did not influence PCEA meperidine consumption, analgesia outcomes, or QoR. Normeperidine did not accumulate in patients of either study group during the 48-hr study period. Meperidine for patientcontrolled epidural analgesia, with or without adrenaline, provides effective post-thoracotomy analgesia in selected patients.

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Prognostic models of thirty-day mortality and morbidity after major pulmonary resection

Cited by 256 publications

References 21 publications

Postlobectomy Early Complications

Postlobectomy Early Complications

Surgery for nonsmall cell lung cancer

The addition of adrenaline to thoracic epidural meperidine does not improve analgesia following thoracotomy

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