Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?

Agostini, Paula; Cieslik, H; Rathinam, Sridhar; Bishay, Ehab; Kalkat, Maninder; Rajesh, P.; Steyn, RS; Singh, Sally; Naidu, Babu

doi:10.1136/thx.2009.123083

Cited by 380 publications

(335 citation statements)

References 29 publications

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“…[1][2][3] This is a major concern as up to 20% of surgical patients are smokers. 4,5 A recent large observational study of non-cardiac surgical patients reported that smoking is associated with a 38% increase in the risk of perioperative death and a 30-109% increase in the risk of serious postoperative complications, depending on the type of complication. 3 However, this study did not examine whether short-term abstinence from smoking before surgery reduces the risk of postoperative complications.…”

Section: Résumémentioning

confidence: 99%

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Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

Wong

Lam

Abrishami

et al. 2011

Can J Anesth/J Can Anesth

328

161

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Purpose The literature was reviewed to determine the risks or benefits of short-term (less than four weeks) smoking cessation on postoperative complications and to derive the minimum duration of preoperative abstinence from smoking required to reduce such complications in adult surgical patients. Source We searched MEDLINE, EMBASE, Cochrane, and other relevant databases for cohort studies and randomized controlled trials that reported postoperative complications (i.e., respiratory, cardiovascular, woundhealing) and mortality in patients who quit smoking within six months of surgery. Using a random effects model, meta-analyses were conducted to compare the relative risks of complications in ex-smokers with varying intervals of smoking cessation vs the risks in current smokers. Principal findings We included 25 studies. Compared with current smokers, the risk of respiratory complications was similar in smokers who quit less than two or two to four weeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96 to 1.50 vs RR 1.14; CI 0.90 to 1.45, respectively). Smokers who quit more than four and more than eight weeks before surgery had lower risks of respiratory complications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53; 95% CI 0.37 to 0.76, respectively). For wound-healing complications, the risk was less in smokers who quit more than three to four weeks before surgery than in current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reported cardiovascular complications and there were few deaths. Conclusion At least four weeks of abstinence from smoking reduces respiratory complications, and abstinence of at least three to four weeks reduces wound-healing complications. Short-term (less than four weeks) smoking cessation does not appear to increase or reduce the risk of postoperative respiratory complications.Author contributions Jean Wong was involved in data abstraction, interpretation of data, drafting and revising, and final approval of the article. David Paul Lam was involved in data abstraction and drafting of the article. Amir Abrishami was involved in drafting and revising the article, data analysis, and interpretation of the data. Matthew Chan revised and approved the final version of the article. Frances Chung was involved in the conception and design, revising, and final approval of the article. (RR: 0,77; IC a`95 %: 0,96 et RR: 0,53; IC a9 5 %: 0,76, respectivement). Concernant les complications lie´es a`la cicatrisation, le risque a e´te´plus faible chez les fumeurs ayant cesse´plus de trois a`quatre semaines avant l'intervention que chez les fumeurs actifs (RR: 0,69; IC a`95%: 0,56-0,84). Peu d'e´tudes ont de´crit des complications cardiovasculaires et il n'y a eu que peu de de´ce`s. Conclusion Un minimum de quatre semaines d'abstinence du tabagisme diminue le risque de complications respiratoires et un minimum de trois a`quatre semaines re´duit le risque de complications lie´es a`la cicatrisation. L'arreˆt à court terme (moins de quatre semaines) du tab...

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Section: Résumémentioning

confidence: 99%

“…4,5 A recent large observational study of non-cardiac surgical patients reported that smoking is associated with a 38% increase in the risk of…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

Wong

Lam

Abrishami

et al. 2011

Can J Anesth/J Can Anesth

328

161

View full text Add to dashboard Cite

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“…However, the patients undergoing lung cancer surgery are susceptible to pulmonary complications because of pain, secretory retention, inefficient cough, and decreased immunity. Postoperative pneumonia (POP) is one of the most frequent complications following thoracic surgery and is strongly associated with high mortality rates (2,3). Many perioperative risk factors have been reported to be associated with an increased incidence of pneumonia after surgery (2,(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Identifying patients at higher risk of pneumonia after lung resection

et al. 2017

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Background: Pneumonia is considered as one of the most common and serious complications after lung resection. The purpose of this study was to identify the risk factors associated with postoperative pneumonia (POP) after lung resection and to develop a scoring system to stratify patients with increased risk of POP.Methods: A retrospective review of a prospective database of patients between September 2014 and June 2016 was carried out. Logistic regression analysis was used to examine the risk factors for POP. Bootstrap resampling analysis was used for internal validation. Regression coefficients were used to develop weighted risk scores for POP.Results: Results revealed that age ≥64 years, smoking (current or previous), high pathological stage, and extent of excision of more than one lobe as risk factors. Logistic regression analysis showed that the predictors of POP were as follows: age ≥64 years, smoking, extent of excision of more than one lobe.A weighted score based on these factors was developed which was follows: smoking (three points), age ≥64 years (four points), and extent of excision of more than one lobe (five points). POP score >5 points offered the best combination of sensitivity (64.7%) and specificity (83.3%), and an area under receiver operating characteristic (ROC) curve ( Conclusions: Patients with older age, smoking and extent of excision of more than one lobe have a higher risk for pneumonia after lung cancer surgery. Also, the scoring system helps to guide decision making of POP risk reduction.

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“…However, the incidence rate of postoperative pulmonary complications (PCs) ranging from 15% to 37% for patients who undergo lobectomy (4)(5)(6), in which prolonged air leak and pneumonia are the most common (7)(8)(9). PCs prolong hospitalization, ICU care, increased medical cost (9,10), but limited researches focus on the potential impact of PCs on long-term survival for lung cancer patients (11).…”

Section: Introductionmentioning

confidence: 99%

The long-term impact of postoperative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer

Wang¹,

Li²,

Li³

et al. 2017

J. Thorac. Dis.

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Background: Pulmonary complications (PCs) may influence long-term survivor. We sought to determine the long-term impacts of major pulmonary complications (MPCs) and identify the independent risk factors in non-small cell lung cancer (NSCLC) patients. Conclusions: MPC after VATS lobectomy is associated with a poorer long-time outcome. The independent risk factors for MPCs were age, male and ASA grade.

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Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?

Cited by 380 publications

References 29 publications

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

Identifying patients at higher risk of pneumonia after lung resection

The long-term impact of postoperative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer

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