Long-term impact of developing a postoperative pulmonary complication after lung surgery
Long-term impact of developing a postoperative pulmonary complication after lung surgery
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DOI：
10.1136/thoraxjnl-2015-207697
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发表时间：
2016-02-01
期刊：
影响因子：
10
通讯作者：
Naidu, Babu
中科院分区：
文献类型：
--
作者：
Lugg, Sebastian T.;Agostini, Paula J.;Naidu, Babu
简介 肺切除术后常见肺不张和肺炎等术后肺部并发症 (PPC)。 PPC 对术后发病率和死亡率具有显着的临床影响。我们研究了 PPC 的长期影响，并试图找出独立的危险因素。方法 一项前瞻性观察性研究涉及区域胸科中心肺切除术后 4 年多的所有患者。每天在医院使用墨尔本小组量表根据胸部 X 光、白细胞计数、发烧、脓痰、微生物学、氧饱和度、医生诊断和重症治疗室 (ITU)/高依赖性病房再入院情况对 PPC 进行评估。随访包括住院时间 (LOS)、30 天再入院和死亡率。结果 670 名接受肺切除术的患者中有 86 名 (13%) 出现了 PPC。这些患者的住院天数显着延长（13 天，95% CI 10.5-14.9 对比 6.3，95% CI 5.9 至 6.7；p < 0.001），并且 ITU 入院率更高（28% 对比 1.9%；p < 0.001）和 30 天再入院率（20.7% 对比 11.9%；p < 0.001）。 0.05）。发生 PPC 的显着独立危险因素是 COPD 和吸烟 (p < 0.05)，而不是年龄。排除术后早期死亡，发生 PPC 会导致几个月内的总生存率显着降低（40，95% CI 34 至 44 vs 46，95% CI 44 至 47；p = 0.006）。患有 PPC 的人非癌症相关死亡率较高（11% vs 5%；p = 0.020）。 PPC 是非小细胞肺癌患者晚期死亡的重要独立危险因素（HR 2.0，95% CI 1.9 至 3.2；p = 0.006）。结论 胸外科手术后发生 PPC 很常见，并且与较差的长期预后相关。
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.