title: Risk and protective factors for major complications after pneumonectomy for lung cancer.
abstract: Pneumonectomy carries a high-risk for postoperative complications. The aim of the study was to identify factors that may predispose to the development of major postoperative complications after pneumonectomy for lung cancer. All consecutive patients from January 2000 to December 2005 were retrospectively studied. Major postoperative complications were defined by respiratory failure, pulmonary embolism, pneumonia, shock, cardiogenic pulmonary oedema, myocardial ischaemia or symptomatic cardiac arrhythmia. One hundred and twenty-nine patients were included. The overall hospital mortality rate was 10.8%, and complications occurred in 42.6%. Multivariate analysis revealed that patients with American Society of Anesthesiologist (ASA) class >2 [odds ratio (OR) 8.26; 95% confidence interval (CI), 3.19-36.55] and liberal fluid administration during surgery (OR, 1.96 for each litre; 95% CI, 1.45-3.16) to be risk factor for major cardiopulmonary complication or mortality. Preoperative haemoglobin > or =10 g/dl (OR, 0.19; 95% CI, 0.01-0.91) and low tidal volume administrated during surgery (< or =7.35 ml/kg; OR, 0.36; 95% CI, 0.10-0.92) were identified as protective factors. Pneumonectomy remains a high-risk surgery. Postoperative complications may be influenced by the comorbidities but also the management of fluid infusion and mechanical ventilation during the surgical procedure.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Tenon University Hospital, UMPC University Paris 06, Paris, France. emmanuel.marret@tnn.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.forename: Farhat
authors.initials: F
authors.lastname: Miled
authors.forename: Bernard
authors.initials: B
authors.lastname: Bazelly
authors.forename: Sonia
authors.initials: S
authors.lastname: El Metaoua
authors.forename: Jacques
authors.initials: J
authors.lastname: de Montblanc
authors.forename: Christophe
authors.initials: C
authors.lastname: Quesnel
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fulgencio
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D016009:Chi-Square Distribution; D015897:Comorbidity; D005440:Fluid Therapy / Q000009:adverse effects; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins