Risk factors for early mortality and morbidity after pneumonectomy: a reappraisal.
BACKGROUND
Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors.


METHODS
The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed.


RESULTS
Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028).


CONCLUSIONS
Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.
Mansour
Ziad
Z
Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Kochetkova
Evgenia A
EA
Santelmo
Nicola
N
Meyer
Pierre
P
Wihlm
Jean-Marie
JM
Quoix
Elisabeth
E
Massard
Gilbert
G
D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors