title: Incidence of major pulmonary morbidity after pneumonectomy: association with timing of smoking cessation.
abstract: BACKGROUND
  The prevention of major pulmonary events (MPEs) after pneumonectomy may minimize postoperative mortality rates. The purpose of this study was to identify preoperative and perioperative factors associated with the development of MPEs after pneumonectomy to help predict which patients are at increased risk for MPEs.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients (n = 261) who underwent pneumonectomies between January 1990 and May 1999. We analyzed preoperative and perioperative risk factors, the primary end point of an MPE and the secondary end points of mortality (in-hospital or 30 days postprocedure), length of stay, and hospital charges. A postoperative MPE included only pneumonia or acute respiratory distress syndrome as defined by the Centers for Disease Control and the American and European Consensus Conference's established criteria. Simple atelectasis that did not progress to pneumonia or a documented aspiration was not included.
  
  
  RESULTS
  Four patients died within 12 hours of operation; the records of the remaining 257 patients were analyzed. An MPE occurred in 33 (12.8%) of 257 patients; 16 (6.2%) of 257 patients died. A multivariate analysis performed on relevant variables showed that only the timing of smoking cessation (1 month or sooner before operation) was a significant predictor of an MPE. Age, side of pneumonectomy, and the use of preoperative chemotherapy or combined chemotherapy and radiation therapy were not significant predictors of an MPE. An MPE significantly increased the mortality rate 2.1% versus 39.3%, p < 0.001).
  
  
  CONCLUSIONS
  Mortality after pneumonectomy increased significantly with the development of an MPE. Patients who continue to smoke within 1 month of operation are at an increased risk for developing an MPE. Interventions to minimize MPEs may minimize the mortality rate after pneumonectomy.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery and Medical Informatics, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. avaporci@mdanderson.org
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Merriman
authors.forename: Ferrah
authors.initials: F
authors.lastname: Ece
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Nesbitt
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Putnam
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D011014:Pneumonia / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D016540:Smoking Cessation / Q000706:statistics & numerical data; D016019:Survival Analysis