Risk Factors for Early Mortality and Morbidity After Pneumonectomy: A Reappraisal

被引:52
作者
Mansour, Ziad
Kochetkova, Evgenia A.
Santelmo, Nicola
Meyer, Pierre
Wihlm, Jean-Marie
Quoix, Elisabeth
Massard, Gilbert [1 ]
机构
[1] Hop Univ Strasbourg, Serv Chirurg Thorac, Dept Biostat, F-67091 Strasbourg, France
关键词
LUNG-CANCER SURGERY; ATRIAL-FIBRILLATION; PULMONARY RESECTION; OPERATIVE MORTALITY; PROGNOSTIC-FACTORS; THORACIC-SURGERY; COMPLICATIONS; PROPHYLAXIS; ARRHYTHMIAS; DILTIAZEM;
D O I
10.1016/j.athoracsur.2009.07.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors. Methods. The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed. Results. Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028). Conclusions. Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.
引用
收藏
页码:1737 / 1744
页数:9
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