Risk and protective factors for major complications after pneumonectomy for lung cancer

Abstract

Pneumonectomy carries a high-risk for postoperative complications. The aim of the study was to identify factors that may predispose to the development of major postoperative complications after pneumonectomy for lung cancer. All consecutive patients from January 2000 to December 2005 were retrospectively studied. Major postoperative complications were defined by respiratory failure, pulmonary embolism, pneumonia, shock, cardiogenic pulmonary oedema, myocardial ischaemia or symptomatic cardiac arrhythmia. One hundred and twenty-nine patients were included. The overall hospital mortality rate was 10.8%, and complications occurred in 42.6%. Multivariate analysis revealed that patients with American Society of Anesthesiologist (ASA) class >2 [odds ratio (OR) 8.26; 95% confidence interval (CI), 3.19-36.55] and liberal fluid administration during surgery (OR, 1.96 for each litre; 95% CI, 1.45-3.16) to be risk factor for major cardiopulmonary complication or mortality. Preoperative haemoglobin > or =10 g/dl (OR, 0.19; 95% CI, 0.01-0.91) and low tidal volume administrated during surgery (< or =7.35 ml/kg; OR, 0.36; 95% CI, 0.10-0.92) were identified as protective factors. Pneumonectomy remains a high-risk surgery. Postoperative complications may be influenced by the comorbidities but also the management of fluid infusion and mechanical ventilation during the surgical procedure.

Volume Management and Resuscitation in Thoracic Surgery

“…Fluid in excess of 2 L total volume administered during pneumonectomy is linked with negative effects on postoperative respiratory outcomes [3,13,15,17], and similar results have been demonstrated with high perioperative fluid loads and lesser pulmonary resections [3,10,16]. In patients with pulmonary fibrosis, higher perioperative fluid volumes and balance are linked to an increased risk of postoperative respiratory compromise after lung resection surgery, a devastating complication [19].…”

“…Other pre-and intra-operative factors have also been implicated, including ASA class [13,14], alcohol abuse [10,14], previous radiotherapy [15] low predicted post-operative lung function [16], non-protective ventilation strategies [17], and right pneumonectomy [7,18].…”

“…Subsequently, fluid administration, both intra-and postoperatively, has repeatedly been found to be a risk factor for the development of ARDS after lung resection [10,13,[15][16][17][18] (see Table 1). Fluid in excess of 2 L total volume administered during pneumonectomy is linked with negative effects on postoperative respiratory outcomes [3,13,15,17], and similar results have been demonstrated with high perioperative fluid loads and lesser pulmonary resections [3,10,16].…”

Risk factors for malignancy-unrelated long-term respiratory events after pneumonectomy

“…Risk factors for malignancy-unrelated long-term respiratory events after pneumonectomy Pneumonectomy is a surgical procedure of which complication rates are still high, and it has been recently performed mostly in the case of malignancy. [1] Furthermore, as it involves the loss of an organ, pneumonectomy is a debilitating surgery which often includes comorbidities that negatively affect the quality of life of patients. [1] Some patients undergoing pneumonectomy may die due to morbidities related to circulatory and respiratory failure in the long-term.…”

“…[1] Furthermore, as it involves the loss of an organ, pneumonectomy is a debilitating surgery which often includes comorbidities that negatively affect the quality of life of patients. [1] Some patients undergoing pneumonectomy may die due to morbidities related to circulatory and respiratory failure in the long-term. [2] Accordingly, some authors advocate the evaluation of data about mortality between 90 days and six months in patients undergoing pneumonectomy for the non-malignancyrelated mortality risk.…”