title: Perioperative mortality after pneumonectomy: analysis of risk factors and review of the literature.
abstract: OBJECTIVE
  To determine risk factors for perioperative death associated with pneumonectomy.
  
  
  METHODS
  A retrospective case-control study in which a perioperative death group was compared with a survivor group, and a review of the English literature on the subject.
  
  
  METHODS
  The Montreal General Hospital, a tertiary-care teaching institution.
  
  
  METHODS
  Ninety-two consecutive patients who underwent pneumonectomy between April 1989 and 1994.
  
  
  METHODS
  The effects of age, sex, smoking history, tumour size, type and stage, pulmonary function, cardiovascular risks, comorbidity, preoperative blood values and volume of fluids administered perioperatively. Values from the literature were reported for comparison.
  
  
  RESULTS
  The perioperative death rate was 10.9%. Selection bias and in-hospital values reported in the literature have underestimated the death rate, with actual rates ranging from 7% to 11%. Age (odds ratio 2.48, p = 0.04), the presence of 1 or more comorbid diseases (odds ratio 7.92, p = 0.05) and amount of fluids given in the first 12 hours postoperatively (odds ratio 2.21, p = 0.06) were found to be significant risk factors for death. Multivariate logistic regression demonstrated that the volume of fluids given remains an independent risk factor whereas age and comorbid disease are dependent variables.
  
  
  CONCLUSIONS
  The results were consistent with previously reported death rates and risk factors. Patient age and concomitant disease are not modifiable risk factors, but perioperative fluid administration and other means to prevent postpneumonectomy pulmonary edema may reduce the perioperative death rate.
authors.affiliation: Department of Surgery, Montreal General Hospital, Que.
authors.forename: D E
authors.initials: DE
authors.lastname: Swartz
authors.forename: K
authors.initials: K
authors.lastname: Lachapelle
authors.forename: J
authors.initials: J
authors.lastname: Sampalis
authors.forename: D S
authors.initials: DS
authors.lastname: Mulder
authors.forename: R C
authors.initials: RC
authors.lastname: Chiu
authors.forename: J
authors.initials: J
authors.lastname: Wilson
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D011654:Pulmonary Edema / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors