Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study

Bevilacqua Filho, Clovis T.; Schmidt, André P.; Felix, Elaine A.; Bianchi, Fabiana; Guerra, Fernanda M.; Andrade, Cristiano F.

doi:10.1016/j.bjane.2021.02.003

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Anesthesiology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

CLINICAL RESEARCH • para Braz. J. Anesthesiol. 71 (4) • Jul-Aug 2021 • https://doi.org/10.1016/j.bjane.2021.02.003 copy

Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Postoperative pulmonary complications are the main cause of morbidity and mortality after pulmonary resection. This study was undertaken to determine the risk factors associated with postoperative pulmonary complications (PPCs) and length of hospital stay (LOS) in pulmonary resection patients in a tertiary teaching hospital in Brazil.

Methods

A retrospective data gathering from 196 patients who underwent pulmonary resection between 2012 and 2016 was conducted. Demographic and hospital admission data were collected from patients with complete medical records. Univariate analysis was performed, followed by Poisson's regression for predicting the prevalence of postoperative pulmonary complications and length of hospital stay.

Results

Thirty-nine patients (20%) displayed pulmonary complications in the postoperative period. The risk factors associated with an increased prevalence of postoperative pulmonary complications in a multivariate analysis were: American Society of Anesthesiologists physical status (ASA) ≥ 3 (PR 4.77, p = 0.03, 95% CI: 1.17 to 19.46), predicted diffusion capacity of the lungs for carbon monoxide- corrected single breath (PR 0.98, p < 0.001, 95% CI: 0.96 to 0.99) and age of the patient (PR 1.04; p = 0.01; 95% CI: 1.01 to 1.06). Those associated with an increased prevalence of prolonged hospital stay were: duration of surgical procedure longer than five hours (PR 6.94, p = 0.01, 95% CI: 1.66 to 12.23), male sex (PR 5.72, p < 0.001, 95% CI: 1.87 to 9.58), and presence of postoperative pulmonary complications (PR 11.92, p < 0.001, 95% CI: 7.42 to 16.42).

Conclusions

The rate of postoperative pulmonary complications in the study population is in line with the world average. Recognizing risk factors for the development of PPCs may help optimize allocation resources and preventive efforts.

KEYWORDS
Pleural effusion; Pneumonia; Pneumothorax; Acute respiratory distress syndrome; Pulmonary atelectasis; Thoracotomy; Ventilator-induced lung injury

Variable	Patients (%)	Patients with PPC (%)
Age
< 55 years	61 (31.1)	4 (10.3)
55-65 years	56 (28.6)	8 (20.5)
≥ 65 years	79 (40.3)	27 (69.2)
Gender
Male	97 (49.5)	22 (65.4)
Female	99 (50.5)	17 (43.6)
ASA
ASA 1	3 (1.5)	0
ASA 2	70 (35.7)	4 (10.3)
ASA 3 or higher	122 (62.2)	35 (89.7)
COPD
Absent	75 (38.3)	9 (23.1)
Mild	90 (45.9)	16 (41)
Moderate	21 (10.7)	7 (17.9)
Severe	10 (5.1)	7 (17.9)
Surgical technique
Segmentectomy	86 (43.9)	10 (25.6)
Lobectomy	98 (50)	25 (64.1)
Bilobectomy	8 (4.1)	3 (7.7)
Pneumonectomy	4 (2.0)	1 (2.6)
FVC^a a Values for FVC, FEV1 and DLCO are presented as mean ± standard deviation.	83.16 ± 17.97%	76.74 ± 20.12%
FEV₁^a a Values for FVC, FEV1 and DLCO are presented as mean ± standard deviation.	78.71 ± 20.80%	66.79 ± 23.18%
DL_CO^a a Values for FVC, FEV1 and DLCO are presented as mean ± standard deviation.	60.73 ± 18.91%	51.75 ± 15.10%

Postoperative pulmonary complication	Number of patients (%)
Pneumonia	32 (82)
Atelectasis	10 (26)
Bronchospasm	5 (13)
Pneumothorax	1 (3)
Pleural effusion	4 (10)
Acute Respiratory Distress Syndrome	2 (5)
Gastric content aspiration	0 (0)
Hypoxemia	6 (15)
Total Number of Patients with one or more PPC	39 (20)
Death from PPC	8 (4)

Variables entered into the Poisson's regression model	OR	p-value	95% CI (Wald)
Age	1.04	< 0.001	1.02	1.07
Charlson Comorbidity Index	0.12	0.02	0.05	0.20
No. of pulmonary subsegments removed	1.05	0.02	1.01	1.10
ppoDL_CO-cSB	0.97	0.001	0.95	0.99
ppoFEV₁	0.89	0.002	0.82	0.96
ASA
3 or higher	3.81	0.006	1.11	6.51
Smoking history
> 21 packs-year	1.60	0.032	1.08	6.27
COPD
Moderate-severe	3.76	< 0.001	1.82	7.77
Duration of surgical procedure
> 5 hours	6.32	0.003	1.88	21.18
Non-pyogenic lung infection	3.97	< 0.001	2.17	6.94
Functional status (dependent-partially dependent)	4.74	< 0.001	3.00	7.48
Surgical technique*	2.26	0.015	1.17	4.39

	Prevalence ratio	p-value	95% CI (Wald)
ASA 3 or higher	4.77	0.03	1.17	19.46
Age	1.04	0.01	1.01	1.06
ppoDL_CO-cSB	0.98	< 0.001	0.96	0.99

Variable	Odds Ratio	p-value	95% CI (Wald)
BMI (kg m^-2)	0.41	0.02	0.32	0.611
No. of pulmonary subsegments removed	0.40	< 0.001	0.12	0.67
Male sex	3.72	0.01	1.81	6.64
ASA-PS 3 or higher	3.82	< 0.001	1.12	6.52
COPD moderate-severe	5.9	0.01	1.59	10.21
Duration of surgical procedure > 5 hours	11.97	< 0.001	7.56	16.38
Non-pyogenic lung infection	19.20	< 0.001	11.69	26.71
Functional status (dependent-partially dependent)	14.96	< 0.001	9.77	20.11
Postoperative pulmonary complications	16.22	< 0.001	13.29	19.15
ppoDL_CO-cSB	0,88	0.29	0,78	0,98
ppoFEV₁	0.89	0.02	0.82	0.96

	Prevalence Ratio	p-value	95% CI (Wald)
Male sex	5.72	< 0.001	1.87	9.58
Duration of Surgical Procedure > 5 hours	6.94	0.01	1.66	12.23
Postoperative Pulmonary Complications	11.92	< 0.001	7.42	16.42

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail: ctbfilho@gmail.com (C.T. Bevilacqua Filho).