1
|
Duchnowski P, Śmigielski W. Risk Factors of Postoperative Hospital-Acquired Pneumonia in Patients Undergoing Cardiac Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1993. [PMID: 38004042 PMCID: PMC10672909 DOI: 10.3390/medicina59111993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/24/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives. Hospital-acquired pneumonia is one of the complications that may occur in the postoperative period in patients undergoing heart valve surgery, which may result in prolonged hospitalization, development of respiratory failure requiring mechanical ventilation or even death. This study investigated the preoperative risk factors of postoperative pneumonia after heart valve surgery. Materials and Methods: This was a prospective study in a group of consecutive patients with hemodynamically significant valvular heart disease undergoing valve surgery. The primary endpoint at the in-hospital follow-up was hospital-acquired pneumonia after heart valve surgery. Logistic regression analysis was used to assess which variables were predictive of the primary endpoint, and odds ratios (ORdis) were calculated with a 95% confidence interval (CI). Multivariate analysis was based on the results of single-factor logistic regression, i.e., in further steps all statistically significant variables were taken into consideration. Results: The present study included 505 patients. Postoperative pneumonia occurred in 23 patients. The mean time to diagnosis of pneumonia was approximately 3 days after heart valve surgery (±2 days). In multivariate analysis, preoperative level of high-sensitivity Troponin T (hs-TnT) (OR 2.086; 95% CI 1.211-3.593; p = 0.008) and right ventricular systolic pressure (RVSP) (OR 1.043; 95% CI 1.018-1.067; p 0.004) remained independent predictors of the postoperative pneumonia. Of the patients with postoperative pneumonia, 3 patients died due to the development of multiple organ dysfunction syndrome (MODS). Conclusions: Preoperative determination of serum hs-TnT concentration and echocardiographic measurement of the RVSP parameter may be useful in predicting postoperative pneumonia in patients undergoing heart valve surgery.
Collapse
Affiliation(s)
- Piotr Duchnowski
- Ambulatory Care Unit, Cardinal Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | | |
Collapse
|
2
|
Lee HY, Chung YJ, Wang HJ, Chiang XH, Chen LW, Lin YT, Lee YC, Hsu HH, Chang YC, Chen CM, Lin MW, Chen JS. Automated 3D segmentation of the aorta and pulmonary artery for predicting outcomes after thoracoscopic lobectomy in lung cancer patients. Front Oncol 2022; 12:1027036. [DOI: 10.3389/fonc.2022.1027036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPreoperative two-dimensional manual measurement of pulmonary artery diameter in a single-cut axial view computed tomography (CT) image is a commonly used non-invasive prediction method for pulmonary hypertension. However, the accuracy may be unreliable. Thus, this study aimed to evaluate the correlation of short-term surgical outcomes and pulmonary artery/aorta (PA/Ao) diameter ratio measured by automated three-dimensional (3D) segmentation in lung cancer patients who underwent thoracoscopic lobectomy.Materials and methodsWe included 383 consecutive lung cancer patients with thin-slice CT images who underwent lobectomy at a single institute between January 1, 2011 and December 31, 2019. Automated 3D segmentation models were used for 3D vascular reconstruction and measurement of the average diameters of Ao and PA. Propensity-score matching incorporating age, Charlson comorbidity index, and lobectomy performed by uniportal VATS was used to compare clinical outcomes in patients with PA/Ao ratio ≥1 and those <1.ResultsOur segmentation method measured 29 (7.57%) patients with a PA/Ao ratio ≥1. After propensity-score matching, a higher overall postoperative complication classified by the Clavien–Dindo classification (p = 0.016) were noted in patients with 3D PA/Ao diameter ratio ≥1 than those of <1. By multivariate logistic regression, patients with a 3D PA/Ao ratio ≥ 1 (p = 0.013) and tumor diameter > 3 cm (p = 0.002) both significantly predict the incidence of postoperative complications.ConclusionsPulmonary artery/aorta diameter ratio ≥ 1 measured by automated 3D segmentation may predict postoperative complications in lung cancer patients who underwent lobectomy.
Collapse
|
3
|
Wang HJ, Chen LW, Lee HY, Chung YJ, Lin YT, Lee YC, Chen YC, Chen CM, Lin MW. Automated 3D Segmentation of the Aorta and Pulmonary Artery on Non-Contrast-Enhanced Chest Computed Tomography Images in Lung Cancer Patients. Diagnostics (Basel) 2022; 12:diagnostics12040967. [PMID: 35454015 PMCID: PMC9032785 DOI: 10.3390/diagnostics12040967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022] Open
Abstract
Pulmonary hypertension should be preoperatively evaluated for optimal surgical planning to reduce surgical risk in lung cancer patients. Preoperative measurement of vascular diameter in computed tomography (CT) images is a noninvasive prediction method for pulmonary hypertension. However, the current estimation method, 2D manual arterial diameter measurement, may yield inaccurate results owing to low tissue contrast in non-contrast-enhanced CT (NECT). Furthermore, it provides an incomplete evaluation by measuring only the diameter of the arteries rather than the volume. To provide a more complete and accurate estimation, this study proposed a novel two-stage deep learning (DL) model for 3D aortic and pulmonary artery segmentation in NECT. In the first stage, a DL model was constructed to enhance the contrast of NECT; in the second stage, two DL models then applied the enhanced images for aorta and pulmonary artery segmentation. Overall, 179 patients were divided into contrast enhancement model (n = 59), segmentation model (n = 120), and testing (n = 20) groups. The performance of the proposed model was evaluated using Dice similarity coefficient (DSC). The proposed model could achieve 0.97 ± 0.007 and 0.93 ± 0.002 DSC for aortic and pulmonary artery segmentation, respectively. The proposed model may provide 3D diameter information of the arteries before surgery, facilitating the estimation of pulmonary hypertension and supporting preoperative surgical method selection based on the predicted surgical risks.
Collapse
Affiliation(s)
- Hao-Jen Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
| | - Li-Wei Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
| | - Hsin-Ying Lee
- Department of Medicine, National Taiwan University, Taipei 100, Taiwan; (H.-Y.L.); (Y.-C.L.)
| | - Yu-Jung Chung
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
| | - Yan-Ting Lin
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
| | - Yi-Chieh Lee
- Department of Medicine, National Taiwan University, Taipei 100, Taiwan; (H.-Y.L.); (Y.-C.L.)
| | - Yi-Chang Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
| | - Chung-Ming Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (H.-J.W.); (L.-W.C.); (Y.-J.C.); (Y.-T.L.); (Y.-C.C.)
- Correspondence: (C.-M.C.); (M.-W.L.)
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (C.-M.C.); (M.-W.L.)
| |
Collapse
|
4
|
Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, Swanson SJ. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg 2021; 162:1605-1618.e6. [PMID: 34716030 DOI: 10.1016/j.jtcvs.2021.07.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. METHODS The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. RESULTS The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. CONCLUSIONS Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
Collapse
Affiliation(s)
- Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa.
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James University Hospital, Leeds, United Kingdom
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Homa Keshavarz
- The American Association for Thoracic Surgery, Beverly, Mass
| | - Peter Mazzone
- Department of Pulmonology, Cleveland Clinic, Cleveland, Ohio
| | - Garrett Walsh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Michael Liptay
- Department of Thoracic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Tex
| | | | - Sudish Murthy
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
| | - M Blair Marshall
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Betty Tong
- Department of Thoracic Surgery, Duke University Hospital, Durham, NC
| | - Michael Lanuti
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Andrea Wolf
- The Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, NY
| | - Brian Pettiford
- Section of Cardiothoracic Surgery, Ochsner Health System, New Orleans, La
| | - Billy W Loo
- Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif
| | - Robert E Merritt
- Division of Thoracic Surgery, The Ohio State University-Wexner Medical Center, Columbus, Ohio
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Thomas K Varghese
- Division of Thoracic Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Scott J Swanson
- Division of Thoracic Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.
| | | |
Collapse
|
5
|
Forbes LM, Gu S, Badesch DB. Surrogate Markers for Pulmonary Hypertension May Inform Prognosis in Lung Cancer. Am J Respir Crit Care Med 2021; 203:1220-1221. [PMID: 33789070 PMCID: PMC8456479 DOI: 10.1164/rccm.202103-0740ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lindsay M Forbes
- Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Sue Gu
- Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - David B Badesch
- Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora, Colorado
| |
Collapse
|
6
|
Commentary: Comparing apples to oranges can bear fruit. J Thorac Cardiovasc Surg 2021; 163:1531-1532. [PMID: 33714578 DOI: 10.1016/j.jtcvs.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/23/2022]
|
7
|
Kneuertz PJ, Yudovich MS, Amadi CC, Bashian E, D'Souza DM, Abdel-Rasoul M, Merritt RE. Pulmonary artery size on computed tomography is associated with major morbidity after pulmonary lobectomy. J Thorac Cardiovasc Surg 2021; 163:1521-1529.e2. [PMID: 33685731 DOI: 10.1016/j.jtcvs.2021.01.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the relationship of pulmonary artery diameter (PAD) measured by computed tomography (CT) with outcomes following lobectomy. METHODS Records of patients undergoing pulmonary lobectomy for lung cancer between 2011 and 2018 were reviewed. Baseline characteristics and postoperative outcome data were derived from the institutional Society of Thoracic Surgeons database. Luminal diameter of the central pulmonary arteries and ascending aorta were measured on preoperative CTs. Logistic regression analyses were performed to test the association of PAD with complications. RESULTS A total of 736 lobectomy patients were included, who had a preoperative CT scan (25% with contrast, 75% noncontrast) available for review. A total of 141 (19.2%) patients had an enlarged main PAD ≥30 mm, and 58 (7.9%) patients had a main PAD that was larger than the ascending aorta (PA/ascending aorta ratio > 1). The right or left PAD on the surgical side was associated with major complication (odds ratio per mm, 1.12; 95% confidence interval, 1.05-1.18; P < .001), unexpected intensive care unit admission (odds ratio per millimeter, 1.11; 95% confidence interval, 1.04-1.19; P = .002), and 30-day mortality (odds ratio per millimeter, 1.25; 95% confidence interval, 1.06-1.46; P = .007). On multivariable analysis, adjusted for cardiovascular comorbidities, pulmonary function, and the operative approach, surgical side PAD remained an independent factor associated with major complication. CONCLUSIONS CT-based measurements of the PAD on the operative side may inform of the about the risk of major complications after lobectomy. Review of PA size on preoperative CT scans may help identify patients who would benefit from formal evaluation of PA pressures to improve the operative risk assessment.
Collapse
Affiliation(s)
- Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Max S Yudovich
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Chiemezie C Amadi
- Division of Thoracic Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth Bashian
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
8
|
Ji-Xu A, Yang Y, Bradley KM. Pulmonary artery enlargement on routine staging 18F-fluodeoxyglucose positron emission tomography/CT for lung and oesophageal cancer. Br J Radiol 2020; 93:20200323. [PMID: 32584599 DOI: 10.1259/bjr.20200323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Pulmonary hypertension (PH) is an underdiagnosed condition associated with poor survival and increased post-operative mortality in lung cancer. CT-based parameters of pulmonary artery enlargement are strong predictors of PH. We used these parameters to investigate pulmonary artery enlargement in lung and oesophageal cancer. METHODS Consecutive patients with lung cancer (n = 100) or oesophageal cancer (n = 100) undergoing staging 18F-fluodeoxyglucose PET/CT were retrospectively identified. The transverse diameter of the main pulmonary artery (mPA) and ascending aorta, and the pulmonary artery-to-ascending aorta (PA:A) ratio were obtained. Abnormal values were defined following the Framingham Heart Study cohort. RESULTS Lung cancer patients had a significantly increased mPA diameter compared to the oesophageal cancer patients (males: 27.29 ± 0.39 vs. 25.88 ± 0.24 mm, females: 26.10 ± 0.28 vs. 24.45 ± 0.18 mm). Similarly, a significantly increased proportion of these patients had an abnormal mPA diameter (males: 35.1% vs 12.5%, females: 32.6% vs 10.7%). Lung cancer patients also had a significantly higher PA:A ratio (males: 0.83 ± 0.01 vs. 0.79 ± 0.008, females: 0.85 ± 0.01 vs. 0.79 ± 0.009), with a larger proportion having an abnormal PA:A ratio (males: 24.6% vs 11.1%, females: 27.9% vs 14.3%). CONCLUSION Simple measurements of mPA diameter and PA:A ratio reveal that lung cancer patients exhibit increased rates of pulmonary artery enlargement compared to oesophageal cancer patients. ADVANCES IN KNOWLEDGE This study demonstrates there is an increased prevalence of pulmonary enlargement in lung cancer, easily detected on routine staging scans, holding implications for further work-up and risk stratification.
Collapse
Affiliation(s)
- Antonio Ji-Xu
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Yunfei Yang
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kevin M Bradley
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Wales Research and Diagnostic PET Imaging Centre, University Hospital Wales, Cardiff, United Kingdom
| |
Collapse
|
9
|
Asakura K. Predictor of cardiopulmonary complication after pulmonary resection. J Thorac Dis 2019; 11:S404-S407. [PMID: 30997232 DOI: 10.21037/jtd.2018.11.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Fu D, Wu C, Li X, Chen J. Elevated preoperative heart rate associated with increased risk of cardiopulmonary complications after resection for lung cancer. BMC Anesthesiol 2018; 18:94. [PMID: 30045695 PMCID: PMC6060559 DOI: 10.1186/s12871-018-0558-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The study aimed to assess whether preoperative resting heart rate could be a risk factor for cardiopulmonary complications (CPCs) after lung cancer resection. METHODS Eligible consecutive patients who underwent resection surgery for non-small cell lung cancer (NSCLC) at Ningbo NO.2 Hospital between May, 2010 and July, 2015 were included. The demographic, clinical characteristics and laboratory parameters were compared in patients with or without CPCs within postoperative 30 days. The multivariate logistic regression analysis was used to analyze the association between CPCs and risk factors. Receiver operating characteristic (ROC) curve analysis was utilized for the predictive role of preoperative resting heart rate for CPCs. RESULTS One hundred eighty participants were enrolled into the final analysis and 42 of them had an established diagnosis of CPCs within postoperative 30 days. Elevated preoperative resting heart rate was an independent risk factor for postoperative CPCs (OR: 4.48, 95% CI: 1.17-18.42, P = 0.021) by the multivariate logistic regression analysis. ROC curve analysis indicated elevated resting heart rate as a predictor for CPCs with a cut-off value of 86 beats/min (AUC: 0.813, specificity: 80.95%, sensitivity: 72.46%, P < 0.001). CONCLUSIONS Elevated preoperative resting heart rate was associated with an increased risk of postoperative CPCs in patients after resection for lung cancer.
Collapse
Affiliation(s)
- Danxia Fu
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Chaoshuang Wu
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Xiaoyu Li
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Junping Chen
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| |
Collapse
|
11
|
Li S, Zhou K, Lai Y, Shen C, Wu Y, Che G. Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study. BMC Surg 2018; 18:29. [PMID: 29792183 PMCID: PMC5966911 DOI: 10.1186/s12893-018-0360-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 05/09/2018] [Indexed: 02/05/2023] Open
Abstract
Background The purpose of our study was to estimate the influence of estimated intraoperative blood loss (EIBL) on postoperative cardiopulmonary complications (PCCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). Methods We conducted a single-center retrospective analysis on the clinical data of consecutive patients in our institution between April 2015 and February 2016. Demographic differences between PCC group and non-PCC group were initially assessed. Receiver operating characteristic (ROC) analysis was performed to determine the threshold value of EIBL for the prediction of PCCs. Demographic differences in the PCC rates and length of stay between two groups of patients divided by this cutoff were further evaluated. A multivariable logistic-regression model involving the clinicopathological parameters with P-value< 0.05 was finally established to identify independent risk factors for PCCs. Results A total of 429 patients with operable NSCLC were included and 80 of them developed PCCs (rate = 18.6%). The mean EIBL in PCC group was significantly higher than that in non-PCC group (133.3 ± 191.3 vs. 79.1 ± 107.1 mL; P < 0.001). The ROC analysis showed an EIBL of 100 mL as the threshold value at which the joint sensitivity (50.0%) and specificity (73.4%) was maximal. The PCC rate in patients with EIBL≥100 mL was significantly higher than that in patients with EIBL< 100 mL (30.1 vs. 13.5%; P < 0.001). Both the length of stay and chest tube duration were significantly prolonged in the patients with EIBL≥100 mL. Finally, EIBL≥100 mL was identified to be predictive of PCCs by multivariable logistic-regression analysis (odds ratio = 3.01; 95% confidence interval = 1.47–6.16; P = 0.003). Conclusions EIBL serves as a significant categorical predictor for cardiopulmonary complications following VATS lobectomy for NSCLC. Thoracic surgeons should minimize the EIBL and strive for the ‘bloodless’ goal to optimize surgical outcomes. Electronic supplementary material The online version of this article (10.1186/s12893-018-0360-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanming Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|