A clinical prediction rule for pulmonary complications after thoracic surgery for primary lung cancer Journal Article
| Authors: | Amar, D.; Munoz, D.; Shi, W.; Zhang, H.; Thaler, H. T. |
| Article Title: | A clinical prediction rule for pulmonary complications after thoracic surgery for primary lung cancer |
| Abstract: | Background: There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery. Methods: Using a prospective database, we performed an analysis of 956 patients who had resection for lung cancer at a single institution. PC was defined as the occurrence of any of the following: atelectasis, pneumonia, pulmonary embolism, respiratory failure, and need for supplemental oxygen at hospital discharge. Results: PCs occurred in 121 of 956 patients (12.7%). Preoperative chemotherapy (odds ratio 1.64, 95% confidence interval 1.06-2.55, P = 0.02, point score 2) and a lower DLCOppo (odds ratio per each 5% decrement 1.13, 95% confidence interval 1.06-1.19, P < 0.0001, point score 1 per each 5% decrement of DLCOppo less than 100%) were independent risk factors for PCs. We defined 3 overall risk categories for PCs: low ≤10 points, 39 of 448 patients (9%); intermediate 11-13 points, 37 of 256 patients (14%); and high ≥14 points, 42 of 159 patients (26%). The median (range) length of hospital stay was significantly greater for patients who developed PCs than for those who did not: 12 (3-113) days vs 6 (2-39) days, P < 0.0001, respectively. Similarly, 30-day mortality was significantly more frequent for patients who developed PCs than for those who did not: 16 of 121 (13.2%) vs 6 of 835 (0.7%), P < 0.0001. Conclusions: These data show that PCs after thoracic surgery for lung cancer can be predicted with moderate accuracy based on DLCOppo and whether patients had chemotherapy. Forced expired volume in 1 s was not a predictor of PCs. Copyright © 2010 International Anesthesia Research Society. |
| Keywords: | cancer chemotherapy; aged; middle aged; antibiotic agent; cancer surgery; primary tumor; major clinical study; mortality; cisplatin; paclitaxel; preoperative care; carboplatin; etoposide; antineoplastic combined chemotherapy protocols; lung neoplasms; lung cancer; prediction; risk factor; vinblastine; risk assessment; pneumonia; lung embolism; postoperative complication; postoperative complications; length of stay; hospitalization; heart infarction; predictive value of tests; atelectasis; hospital discharge; morphine; walking; mitomycin; regression analysis; health care costs; forced expiratory volume; analysis of variance; bupivacaine; patient controlled analgesia; thorax surgery; lung infiltrate; oxygen supply; multiple organ failure; fentanyl; respiratory failure; thoracic surgical procedures; postoperative analgesia; carbon monoxide; isoflurane; vecuronium; lung complication; lung diffusion; anaerobic threshold; lung diseases; pulmonary diffusing capacity; spirometry |
| Journal Title: | Anesthesia and Analgesia |
| Volume: | 110 |
| Issue: | 5 |
| ISSN: | 0003-2999 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2010-05-01 |
| Start Page: | 1343 |
| End Page: | 1348 |
| Language: | English |
| DOI: | 10.1213/ANE.0b013e3181bf5c99 |
| PUBMED: | 19861366 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: AACRA" - "Source: Scopus" |
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