Thromboembolism after pneumonectomy for malignancy: an independent marker of poor outcome.
OBJECTIVE
Because venous thromboembolism results in important postoperative morbidity and mortality after pneumonectomy for malignancy, we sought to determine its prevalence, location, management, timing, and risk factors. We also evaluated short- and long-term outcomes of patients in whom venous thromboembolism developed compared with those of patients in whom it did not.


METHODS
Between January 1990 and January 2001, 336 patients underwent pneumonectomy for malignancy. Patients were considered to have venous thromboembolism if they were identified as having deep vein thrombosis or pulmonary embolus through chart review, including pulmonary imaging studies. All patients were managed with anticoagulation or anticoagulation plus thrombolysis.


RESULTS
Twenty-five (7.4%) patients had postoperative venous thromboembolism, with peak incidence 7 days after the operation; most had already been discharged from the hospital. Higher pack-years of smoking was associated with increased risk, as well as with earlier occurrence of venous thromboembolism (P < .04). Survival was 55% at 6 months and 13% at 18 months; mode of death was cancer in 14 (61%) of 23, respiratory failure in 4 (17%) of 23, multisystem organ failure in 3 (13%) of 23, myocardial infarction in 1 (4.4%) of 23, and uncertain in 1 (4.4%) of 23. Low preoperative forced vital capacity was predictive of poor long-term survival (P = .02). Patients with venous thromboembolism had substantially lower survival than predicted from competing-risks analysis of survival without venous thromboembolism (13% vs 60% at 18 months), and this difference persisted after censoring for deaths directly attributable to venous thromboembolism.


CONCLUSIONS
Venous thromboembolism is surprisingly common after pneumonectomy for malignancy and portends poor survival. Improved screening and better prophylaxis might prevent this complication and enhance outcome.
Mason
David P
DP
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. masond2@ccf.org
Quader
Mohammad A
MA
Blackstone
Eugene H
EH
Rajeswaran
Jeevanantham
J
DeCamp
Malcolm M
MM
Murthy
Sudish C
SC
Quader
Angela K
AK
Rice
Thomas W
TW
D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors