Long-term impact of developing a postoperative pulmonary complication after lung surgery.

Lugg, Sebastian T, Agostini, Paula J, Tikka, Theofano, Kerr, Amy, Adams, Kerry, Bishay, Ehab, Kalkat, Maninder S, Steyn, Richard S, Rajesh, Pala B, Thickett, David R and Naidu, Babu V (2016) Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 71 (2). pp. 171-6. ISSN 1468-3296. This article is available to all HEFT staff and students via http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://thorax.bmj.com/content/71/2/171?hwoasp=auth...

Abstract

INTRODUCTION

Postoperative pulmonary complications (PPC) such as atelectasis and pneumonia are common following lung resection. PPCs have a significant clinical impact on postoperative morbidity and mortality. We studied the long-term effects of PPCs and sought to identify independent risk factors.

METHODS

A prospective observational study involved all patients following lung resection in a regional thoracic centre over 4 years. PPCs were assessed daily in hospital using the Melbourne group scale based on chest X-ray, white cell count, fever, purulent sputum, microbiology, oxygen saturations, physician diagnosis and intensive therapy unit (ITU)/high-dependency unit readmission. Follow-up included hospital length of stay (LOS), 30-day readmissions, and mortality.

RESULTS

86 of 670 patients (13%) who had undergone a lung resection developed a PPC. Those patients had a significantly longer hospital LOS in days (13, 95% CI 10.5-14.9 vs 6.3, 95% CI 5.9 to 6.7; p<0.001) and higher rates of ITU admissions (28% vs 1.9%; p<0.001) and 30-day hospital readmissions (20.7% vs 11.9%; p<0.05). Significant independent risk factors for development of PPCs were COPD and smoking (p<0.05), not age. Excluding early postoperative deaths, developing a PPC resulted in a significantly reduced overall survival in months (40, 95% CI 34 to 44 vs 46, 95% CI 44 to 47; p=0.006). Those who developed a PPC had a higher rate of non-cancer-related deaths (11% vs 5%; p=0.020). PPC is a significant independent risk factor for late deaths in non-small cell lung cancer patients (HR 2.0, 95% CI 1.9 to 3.2; p=0.006).

CONCLUSIONS

Developing a PPC after thoracic surgery is common and is associated with a poorer long-term outcome.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Thoracic Surgery
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Depositing User: Mrs Caroline Tranter
Date Deposited: 24 Feb 2017 10:03
Last Modified: 24 Feb 2017 10:03
URI: http://www.repository.uhblibrary.co.uk/id/eprint/1201

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