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Pulmonary Complications Following Lung Resection^*

A Comprehensive Analysis of Incidence and Possible Risk Factors

^* From the Service d’Anesthésie-Réanimation chirurgicale (Drs. Stéphan, Boucheseiche, Hollande, Cheffi, and Bonnet), the Antenne de Biostatistiques et d’Informatique médicale (Dr. Flahault), and the service de Chirurgie thoracique et vasculaire (Dr. Bazelly), Hôpital Tenon 4 rue de la Chine, Paris, France.

Corrrespondence to: François Stéphan, MD, PhD, département d’Anesthésie-Réanimation chirurgicale, Hôpital Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny 94010 Créteil Cedex, France; e-mail:francois.stephan{at}hmn.ap-hop-paris.fr

Study objectives: To assess the incidence and clinical implications of postoperative pulmonary complications (PPCs) after lung resection, and to identify possible associated risk factors.

Design: Retrospective study.

Setting: An 885-bed teaching hospital.

Patients and methods: We reviewed all patients undergoing lung resection during a 3-year period. The following information was recorded: preoperative assessment (including pulmonary function tests), clinical parameters, and intraoperative and postoperative events. Pulmonary complications were noted according to a precise definition. The risk of PPCs associated with selected factors was evaluated using multiple logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Two hundred sixty-six patients were studied (87 after pneumonectomy, 142 after lobectomy, and 37 after wedge resection). Sixty-eight patients (25%) experienced PPCs, and 20 patients (7.5%) died during the 30 days following the surgical procedure. 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 for postoperative mechanical ventilation > 48 min (OR, 1.96; 95% CI, 1.02 to 3.75; p < 0.04) were independent factors associated with the development of PPCs, which was, in turn, associated with an increased mortality rate and the length of ICU or surgical ward stay.

Conclusions: Our results confirm the relevance of the ASA score in a selected population and stress the importance of the length of the surgical procedure and the need for postoperative mechanical ventilation in the development of PPCs. In addition, preoperative pulmonary function tests do not appear to contribute to the identification of high-risk patients.

Key Words: logistic regression analysis • mortality • nosocomial pneumonia • pulmonary complications • pulmonary function tests • risk factors • thoracic surgery

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