Incidence of Stroke After Pneumonectomy and Lobectomy A Nationwide, Register-Based Study
Incidence of Stroke After Pneumonectomy and Lobectomy A Nationwide, Register-Based Study
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DOI：
10.1161/strokeaha.118.024496
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发表时间：
2019-05-01
期刊：
影响因子：
8.3
通讯作者：
Riahi, Sam
中科院分区：
文献类型：
--
作者：
Riddersholm, Signe;Tayal, Bhupendar;Riahi, Sam
背景和目的--全肺切除或肺叶切除后，至少有1条盲肺静脉存在术后血栓形成的潜在风险。我们调查了这些人群中中风的风险，并与背景和肺楔形切除对照组进行了比较。方法-我们使用1996年至2016年丹麦全国登记的数据确定了12965名接受全肺或肺叶切除的患者和6400名接受楔形切除的患者。在多变量Poisson回归分析中，我们估计了接受肺叶或肺切除术的患者与背景人群对照组和接受楔形切除术的患者的卒中发生率比率。我们将我们的分析按天数分层：术后0至30天，31至90天，91至180天，180至365天，并对肺癌患者进行亚组分析。结果：接受全肺或肺叶切除的患者卒中发生率为10.6/1000人年，未暴露于全肺或肺叶切除的患者为2.3/1000人年。在0-30天的多变量Poisson回归分析中，与背景人群相比，有房颤和无房颤患者的全肺切除或肺叶切除与卒中风险增加相关，分别为4.66(95%CI，2.04~7.12)和5.43(95%CI，3.99~7.41)。同样，在肺癌患者中，全肺或肺叶切除后的前30天仍然是中风的危险因素，对于患有房颤的患者(IRR，2.94；95%CI，1.39-6.25)和非房颤患者(IRR，2.56；95%CI，1.86-3.59)。与楔形切除相比，肺叶或全肺切除后0-30天也与卒中风险增加相关(IRR，2.63；95%CI，1.19-5.81)；然而，这种关联在肺癌患者中并不显著(IRR，2.98；95%CI，0.72-12.29)。肺静脉残端是否是中风的危险因素以及预防策略是否相关，还需要进一步的调查。
Background and Purpose-After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls.Methods-We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer.Results-The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95% CI, 2.04-7.12) and 5.43 (95% CI, 3.99-7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95% CI, 1.39-6.25) and for patients without atrial fibrillation (IRR, 2.56; 95% CI, 1.86-3.59). When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95% CI, 1.19-5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95% CI, 0.72-12.29).Conclusions-Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.