Chest
Volume 118, Issue 5, November 2000, Pages 1263-1270
Journal home page for Chest

Clinical Investigations
Surgery
Pulmonary Complications Following Lung Resection: A Comprehensive Analysis of Incidence and Possible Risk Factors

https://doi.org/10.1378/chest.118.5.1263Get rights and content

Study objectives

To assess the incidence and clinicalimplications of postoperative pulmonary complications (PPCs) after lungresection, and to identify possible associated risk factors.

Design

Retrospective study.

Setting

An885-bed teaching hospital.

Patients and methods

Wereviewed all patients undergoing lung resection during a 3-year period.The following information was recorded: preoperative assessment(including pulmonary function tests), clinical parameters, andintraoperative and postoperative events. Pulmonary complications werenoted according to a precise definition. The risk of PPCs associatedwith selected factors was evaluated using multiple logistic regressionanalysis to estimate odds ratios (ORs) and 95% confidence intervals(CIs).

Results

Two hundred sixty-six patients werestudied (87 after pneumonectomy, 142 after lobectomy, and 37 afterwedge resection). Sixty-eight patients (25%) experienced PPCs, and 20patients (7.5%) died during the 30 days following the surgicalprocedure. An American Society of Anesthesiology (ASA) score ≥ 3 (OR,2.11; 95% CI, 1.07 to 4.16; p < 0.02), an operating time > 80 min(OR, 2.08; 95% CI, 1.09 to 3.97; p < 0.02), and the need forpostoperative mechanical ventilation > 48 min (OR, 1.96; 95% CI,1.02 to 3.75; p < 0.04) were independent factors associated with thedevelopment of PPCs, which was, in turn, associated with an increasedmortality rate and the length of ICU or surgical ward stay.

Conclusions

Our results confirm the relevance of the ASAscore in a selected population and stress the importance of the lengthof the surgical procedure and the need for postoperative mechanicalventilation in the development of PPCs. In addition, preoperativepulmonary function tests do not appear to contribute to theidentification of high-risk patients.

Section snippets

Patients

We (F.S., S.B., J.H.) reviewed the charts of all patients whohad undergone pulmonary resection in our institution from January 1994to December 1996. Operability was determined according to existingguidelines for pneumonectomy and lobectomy.15 We alsoregarded a preoperative Pao2 > 60mm Hg and a Paco2 < 45 mm Hg(resting, breathing room air) as requirements before surgery wasundertaken. However, the final decision regarding operability was madeby the attending surgeon, and some patients were

Study Population

Two hundred sixty-six patients (mean age, 59 ± 14 years; 205men and 61 women) underwent pulmonary resections. Lobectomy, the mostcommon operation, was performed in 142 cases (53%), while 87 patients(33%) underwent pneumonectomy, and 37 patients (14%) underwent wedgeresections (Table 1). There was no significant relationship between the complication rateand the operative procedure. Extended resections were performed in 51patients (19%). Two hundred fifteen patients (81%) had malignantneoplasms

Discussion

This retrospective study documents a 25% pulmonary complicationrate in this series of patients scheduled for thoracotomy. The presentstudy demonstrates that ASA physical status, operating time, and needfor prolonged mechanical ventilation were associated with a twofoldincrease in PPCs. PPCs were also strongly associated with an increasedrisk of death and a prolonged hospital stay.

Our study is probably limited by its retrospectivedesign.16 Firstly, pulmonary complications were determinedby chart

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