Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival
Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival
复制标题
DOI：
10.1016/j.rmed.2015.07.008
复制
发表时间：
2015-10-01
影响因子：
4.3
通讯作者：
Thomsen, Reimar W.
中科院分区：
文献类型：
--
作者：
Simonsen, Dennis F.;Sogaard, Mette;Thomsen, Reimar W.
目的：鲜为人知的是风险因素和预后的术后肺炎（POP）的患者接受治疗性肺癌（LC）surgery.Methods：我们遵循了一个全国性的人口为基础的队列7479例LC手术在丹麦1995-2011年。我们使用逻辑回归分析来检查术后30天内POP的危险因素。采用考克斯回归分析POP患者的后续生存率。（3.6%）的患者患有POP。重要的危险因素包括高龄（年龄>= 80岁：（与年龄50-59岁的患者相比，调整后的比值比[aOR] = 3.64; 95% CI：2.17-6.12）），既往肺炎（aOR = 2.68; 95%CI：2.02-3.56），肥胖（aOR = 1.91; 95%CI：0.99-3.69），慢性肺疾病（aOR = 1.90; 95%CI：1.40-2.57）、酗酒（aOR = 1.56; 95%CI：0.81-3.01）和房颤（aOR = 1.42; 95%CI：0.82-2.45）。胸腔镜手术使POP的风险减半，在开胸手术中进行的肺切除术中POP的风险最高。在术后30天存活的患者中，POP患者31-365天死亡率为21.6%，非POP患者为16.8%，1-5年死亡率为62.2%，非POP患者为53.0%。术后31-365天死亡的危险比为1.31（95%CI：1.00-1.73），1-5年死亡的危险比为1.22（95%CI：0.98-1.53）。POP是LC存活率降低的临床标志物。(C)2015爱思唯尔有限公司版权所有。
Objective: Little is known about risk factors and prognosis for postoperative pneumonia (POP) in patients undergoing therapeutic lung cancer (LC) surgery.Methods: We followed a nationwide population-based cohort of 7479 patients with LC surgery in Denmark 1995-2011. We used logistic regression analysis to examine risk factors for POP within 30 days after surgery. Subsequent survival in patients with POP was analyzed with Cox regression.Results: We identified 268 (3.6%) patients with POP. Important risk factors included advanced age (age >= 80 years: (adjusted odds ratio [aOR] = 3.64; 95% CI: 2.17-6.12) as compared to patients aged 50-59 years), previous pneumonia (aOR = 2.68; 95% CI: 2.02-3.56), obesity (aOR = 1.91; 95% CI: 0.99-3.69), chronic pulmonary disease (aOR = 1.90; 95% CI: 1.40-2.57), alcoholism (aOR = 1.56; 95% CI: 0.81-3.01), and atrial fibrillation (aOR = 1.42; 95% CI: 0.82-2.45). Overall thoracoscopic surgery halved the risk of POP and the highest risk of POP was seen in pneumonectomy performed in open thoracotomy. Among patients surviving the 30-day postoperative period, 31-365 day mortality was 21.6% in POP patients vs. 16.8% in non-POP patients, and 1-5-year mortality was 62.2% vs. 53.0%. Adjusted 31-365 day hazard ratio (HR) of death with POP was 1.31 (95% CI: 1.00-1.73), and 1-5 year HR was 1.22 (95% CI 0.98-1.53).Conclusion: Major risk factors for POP following LC surgery are advanced age, previous pneumonia, obesity, chronic pulmonary disease, alcoholism, and atrial fibrillation. POP is a clinical marker for decreased LC survival. (C) 2015 Elsevier Ltd. All rights reserved.