Pulmonary Complications following Major Lung Resection for Benign and Malignant Lung Diseases

Abstract

Objective: To assess the incidence and to identify the possible associated risk factors for postoperative pulmonary complications after major lung resection. Subjects and Methods:One hundred and sixty-eight consecutive patients undergoing major lung resection for benign and malignant lung disease over a 3-year period were included in the study. Preoperative assessment clinical parameters, intraoperative and postoperative events were recorded. Pulmonary complications were noted according to a precise definition. The risk of complications associated with age, comorbidity, forced vital capacity (FVC), blood transfusion and extended operation was evaluated using logistic regression analysis. Results: The mean age of the patients was 47.1 years (range 16–80 years), 137 (77%) patients underwent lobectomy, 23 (14%) pneumonectomy, and 15 (9%) bilobectomy. Forty-six (27%) patients developed postoperative pulmonary complications and 2 (1.1%) died within 30 days following the operation. Age ≧65 years (OR 3.7, 95% CI: 1.5–8.6, p = 0.002), the presence of comorbid cardiopulmonary disease (OR 0.2, 95% CI: 0.1–0.5, p = 0.001), FVC <50% (OR 0.2, 95% CI: 0.1–0.8, p = 0.02), blood transfusion (OR 0.2, 95% CI: 0.1–0.4, p = 0.0001), and extended operation (OR 0.2, 95% CI: 0.07–0.6, p = 0.005) were the identified factors associated with the development of postoperative pulmonary complications, which necessitated an increased length of hospital stay. Conclusion: Postoperative pulmonary complications are more likely to develop in patients with age ≧65 years with comorbid cardiopulmonary disease, FVC <50%, blood transfusion, and extended operation.

Effects of a clinical pathway of pulmonary lobectomy and bilobectomy on quality and cost of care

“…The length of hospital stay could be significantly reduced by 25% without compromising quality of care. On the other hand side, we were not able to show the desired increase in outcome quality, which was not surprising given that the quality in the pre-pathway group was already in the range of figures reported in the literature [2][3][4]. Moreover, the statistical power of our study was too low to detect a small significant increase in quality.…”

“…The surgical technique is standardized and performed according to tumor staging and localization. In spite of major advances in surgical technique and care, morbidity and mortality after major lung resections are still of a considerable magnitude [2][3][4]. Up to 30% of patients undergoing lobectomy suffer from postoperative complications, of which approximately two thirds are minor and one third are nonfatal major Matthias Schwarzbach and Eric Rössner contributed equally to this paper.…”

Factors affecting major morbidity after video-assisted thoracic surgery for lung cancer

“…According to the literature, the surgical procedure-related mortality is 4.4% in patients with lung cancer [6], whereas the incidence of perioperative complications is 27% [7]. Our results demonstrated that mortality within 30 d after VATS was 1.3% (7/525), and the incidence of complications was 6.9% (36/525), obviously lower than those observed after conventional thoracotomy.…”

“…In recent years, video-assisted thoracic surgery (VATS) has been widely applied in the treatment of lung cancer and has been shown to be associated with fewer postoperative complications, without its clinical efficacy being compromised [8e11]. However, postoperative complications still affect the outcome of VATS [6,7], and thus far, few studies have focused on its complications and risk factors in lung cancer. Therefore, to predict and prevent postoperative complications are worthy of further investigation.…”

Intervenção fisioterapêutica pré-operatória para pacientes submetidos à ressecção pulmonar por câncer: revisão sistemática

“…Além disso, a taxa de mortalidade cirúrgica para ressecção pulmonar pode variar de modo consistente conforme o tipo de cirurgia realizada, oscilando entre 2 e 12% (4,6). Alguns estudos têm sugerido identificar e tratar, no período pré-operatório, pacientes com risco de complicações pulmonares pós--operatórias (7).…”