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Original article
Long-term impact of developing a postoperative pulmonary complication after lung surgery
  1. Sebastian T Lugg1,
  2. Paula J Agostini2,3,
  3. Theofano Tikka2,
  4. Amy Kerr2,
  5. Kerry Adams2,
  6. Ehab Bishay2,
  7. Maninder S Kalkat2,
  8. Richard S Steyn2,
  9. Pala B Rajesh2,
  10. David R Thickett1,
  11. Babu Naidu1,2
  1. 1Centre for Translational Inflammation Research (CITR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  2. 2Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
  3. 3School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Babu Naidu, Centre for Translational Inflammation Research (CTIR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK; b.naidu{at}bham.ac.uk

Abstract

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.

  • Thoracic Surgery
  • Lung Cancer
  • Pneumonia
  • COPD Pathology
  • Tobacco and the lung
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