Complications and mortality of pulmonary resection in intensive care units
Keywords:
THORACIC SURGERY, PNEUMONECTOMY, POSTOPERATIVE COMPLICATIONS, CRITICAL CAREAbstract
Objective: to describe frequency of post-operative complications and mortality in a number of patients undergoing a programmed pulmonary resection surgery who were admitted to intensive care units (ICU) immediately after surgery.
Method: observational, retrospective, multi-center study conducted in four health institutions in Montevideo, between 2009 and 2010. One hundred and forty eight patients were included to study demographic variables, personal history, indications and surgical procedure, complications ICU-stay and mortality. A descriptive, statistical, two-variable analysis was conducted, a 95% confidence interval was deemed significant, and p was < 0,05.
Results: crude post-surgery mortality rate during stay in the ICU was 10.1%. Incidence of postoperative complications was 53.3%, being average stay three days with an interquartile range of 3. The main complications were pulmonary, pleural and cardiovascular. Mortality was higher in larger pulmonary resections, patients with chronic obstruction pulmonary disease and in those who evidences respiratory and cardiovascular complications. The main cause of death was severe sepsis. The development of severe sepsis (OR 12.9 IC95%, 5.95-21.24 p < 0,001) and the need for mechanical ventilation (OR 3.7 IC95%, 1.80-8.93 p = 0,001) were independent risk factors associated to mortality.
Conclusions: postoperative morbi-mortality during stay in the ICU is high. The main complications are respiratory and cardiovascular. Development of severe sepsis la morbi-mortalidad and the need for mechanical ventilation were independent factors associated to a higher mortality.
References
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(2) Blank RS, Hucklenbruch C, Gurka KK, Scalzo DC, Wang XQ, Jones DR, et al. Intraoperative factors and the risk of respiratory complications after pneumonectomy. Ann Thorac Surg 2011; 92(4):1188–94.
(3) LaPar DJ, Bhamidipati CM, Lau CL, Jones DR, Kozower BD. The Society of Thoracic Surgeons General Thoracic Surgery Database: establishing generalizability to national lung cancer resection outcomes. Ann Thorac Surg 2012; 94(1):216–21; discussion 221.
(4) Brunelli A, Ferguson M, Rocco G, Pieretti P, Vigneswaran W, Morgan-Hughes J, et al. A scoring system predicting the risk for Intensive care unit admission for complications after major lung resection: A Multicenter Analysis. Ann Thorac Surg 2008; 86(1):213-8.
(5) Roberts JR. Postoperative respiratory failure. Thorac Surg Clin 2006; 16(3):235–41.
(6) Gandía Martínez F, Duque Medina JL, Andaluz Ojeda D, Iñigo Martínez G. Síndrome de distrés respiratorio agudo en el postoperatorio de resección pulmonar. Arch Bronconeumol 2007; 43(11):623-7.
(7) Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in aprospective single-center study. J Cardiothorac Surg 2012; 7:4.
(8) Nan DN, Fernandez-Ayala M, Fariñas-Alvarez C, Mons R, Ortega FJ, González Macías J et al. Nosocomial infection after lung surgery. Chest 2005; 128(4):2647–52.
(9) Gagarine A, Urschel JD, Miller JD, Bennett WF, Young JE. Preoperative and intraoperative factors predictive of length of hospital stay after pulmonary lobectomy. Ann Thorac Cardiovasc Surg 2003; 9(4):222-5.
(10) Amar D, Munoz D, Shi W, Zhang H, Thaler HT. Clinical prediction rule for pulmonary complications after thoracic surgery for primary lung cancer. Anesth Analg 2010; 110(5): 1343–8.
(11) Kim JB, Lee SW, Park S, Kim YH, Kim DK. Risk factor analysis for postoperative acute respiratory distress syndrome and early mortality after pneumonectomy: the predictive value of preoperative lung perfusion distribution. J Thorac Cardiovasc Surg 2010; 140(1):26-31.
(12) Sen S, Sentürk E, Kuman NK. Postresectional lung injury in thoracic surgerypre and intraoperative risk factors: a retrospective clinical study of a hundred fortythree cases. J Cardiothorac Surg 2010; 5:62.
(13) Chandrashekhara SH, Bhalla AS, Sharma R, Gupta AK, Kumar A, Arora R. Imagingin postpneumonectomy complications: A pictorial review. J Cancer Res Ther 2011; 7(1): 3-10.
(14) Kim AW, Boffa DJ, Wang Z, Detterbeck FC. An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non–small cell lung cancer. J Thorac Cardiovasc Surg 2012; 143(1):55-63.
(15) Tabutin M, Couraud S, Guibert B, Mulsant P, Souquet PJ, Tronc F. Completion pneumonectomy in patients with cancer. Postoperative survival and mortality factors. J Thorac Oncol 2012; 7(10):1556–62.
(16) Slinger P. Update on anesthetic management for pneumonectomy. Curr Opin Anaesthesiol 2009; 22(1):31–7.
(17) Brunelli A, Belardinelli R, Pompili C, Xiumé F, Refai M, Salati M. Minute ventilationto-carbon dioxide output (V?E/V?) slope is the strongest predictor of respiratory complications and death after pulmonary resection. Ann Thorac Surg 2012; 93(6):1802–6.
(18) Detterbeck F. Thoracoscopic versus open lobectomy debate: the proargument. Thorac Surg Sci 2009; 6: Doc04.
(19) Mazzone P. Preoperative evaluation of the lung resection candidate. Cleve Clin J Med 2012; 79 Electronic Suppl 1:eS17-22.
(20) Tzani P, Chetta A, Olivieri D. Patient assessment and prevention of pulmonary side effects in surgery. Curr Opin Anaesthesiol 2011; 24(1):2–7.
(21) Licker M, Widikker I, Robert J, Frey J, Spiliopoulos A, Ellenberger C, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 2006; 81(5):1830-7.
(22) Brunelli A, Al Refai M, Monteverde M, Sabbatini A, Xiumé F, Fianchini A. Predictors of early morbidity after major lung resection in patients with and without airflow limitation. Ann Thorac Surg 2002; 74(4):999-1003.
(23) Berry MF, Onaitis MW, Tong BC, Harpole DH, D’Amico TA. A model for morbidityafter lung resection in octogenarians. Eur J Cardiothorac Surg 2011; 39(6):989–94.
(24) Licker M, Diaper J, Villiger Y, Spiliopoulos A, Licker V, Robert J, et al. Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery. Crit Care 2009; 13(2):R41.
(25) Brunelli, A. Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 2009; 34(1):17–41.
(26) Ghosh S, Steyn RS, Marzouk JF, Collins FJ, Rajesh PB. The effectiveness of high dependency unit in the management of high risk thoracic surgical cases. Eur J Cardiothorac Surg 2004; 25(1):123-6.
(27) Mun M, Kohno T. Video-assisted thoracic surgery for clinical stage I lung cancer in octogenarians. Ann Thorac Surg 2008; 85(2):406–11.
(28) Voltolini L, Rapicetta C, Ligabue T, Luzzi L, Scala V, Gotti G. Short- and long-termresults of lung resection for cancer in octogenarians. Asian Cardiovasc Thorac Ann 2009; 17(2):147–52.
(29) Igai H, Takahashi M, Ohata K, Yamashina A, Matsuoka T, Kameyama K, et al. Surgical treatment for non-small cell lung cancer in octogenarians—the usefulness of videoassisted thoracic surgery. Interact Cardiovasc Thorac Surg 2009; 9(2):274–7.
(30) Mansour Z, Kochetkova E, Santelmo N, Meyer P, Wihlm J, Quoix E, et al. Riskfactors for early mortality and morbidity after pneumonectomy: A Reappraisal. Ann Thorac Surg 2009; 88:1737-44.
(31) Berry MF, Hanna J, Tong BC, Burfeind WR, Harpole DH, D’Amico TA, et al. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg 2009; 88:1093-9.
(32) Billmeier SE, Ayanian JZ, Zaslavsky AM, Nerenz DR, Jaklitsch MT, Rogers SO. Predictors and outcomes of limited resection for early-stage non–small cell lung cancer. J Natl Cancer Inst 2011; 103:1621–29.
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Published
2014-03-31
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Tejera D, Verga F, Micol M, Gorrasi J, Cancela M. Complications and mortality of pulmonary resection in intensive care units. Rev. Méd. Urug. [Internet]. 2014 Mar. 31 [cited 2024 Nov. 24];30(1):8-16. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/255
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