title: Intraoperative factors and the risk of respiratory complications after pneumonectomy.
abstract: BACKGROUND
  The potential effect of intraoperative factors on respiratory complications after pneumonectomy is still unclear.
  
  
  METHODS
  We conducted a retrospective cohort study; charts of 129 patients who underwent elective pneumonectomy at the University of Virginia were reviewed. Logistic regression was used to estimate the effect of anesthetic factors on the odds of at least one respiratory complication. Linear regression models were fit to assess the impact of these outcomes on length of stay (LOS).
  
  
  RESULTS
  The incidence of respiratory complications in this cohort was 21%. In univariate analysis total nonblood fluids (p = 0.001), and the blood products packed red blood cells (p < 0.001), plasma (p < 0.001), and platelets (p = 0.044) were significantly associated with respiratory complications. In a multivariable logistic regression analysis, single unit transfusion of any blood product (packed red blood cells, plasma, or platelets) was identified as a major risk factor for respiratory complications after controlling for covariates (odds ratio = 1.47, 95% confidence interval 1.06 to 2.05). Respiratory failure and complications were closely related to LOS, increasing the LOS by a factor of 4.7 (95% confidence interval 3.51 to 6.18) and 3.5 (95% confidence interval 2.69 to 4.41), respectively.
  
  
  CONCLUSIONS
  Blood product transfusion affects respiratory function and is an independent risk factor for respiratory complications after pneumonectomy.
authors.affiliation: Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA. rsb8p@virginia.edu
authors.forename: Randal S
authors.initials: RS
authors.lastname: Blank
authors.forename: Christoph
authors.initials: C
authors.lastname: Hucklenbruch
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Gurka
authors.forename: David C
authors.initials: DC
authors.lastname: Scalzo
authors.forename: Xin-Qun
authors.initials: XQ
authors.lastname: Wang
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Tanner
authors.forename: James M
authors.initials: JM
authors.lastname: Jaeger
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014768:Virginia / Q000453:epidemiology