title: Multivariate analysis of risk factors for pulmonary complications after hepatic resection.
abstract: OBJECTIVE
  To generate the first evaluation of risk factors for postoperative pulmonary complications (PPCs) after hepatectomy.
  
  
  BACKGROUND
  Postoperative pulmonary complications (PPCs) after surgery are associated with significant morbidity and have been shown to increase the length of hospital stays. Several studies have been conducted to identify the risk factors for PPCs after abdominal surgery.
  
  
  METHODS
  Between January 2006 and December 2009, 555 patients underwent elective hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PPCs, pleural effusion, pneumonia, and pulmonary embolism.
  
  
  RESULTS
  Multivariate analysis identified 5 independent risk factors for global PPCs: prolonged surgery [odds ratio (OR) = 1], presence of a nasogastric tube (OR = 1.6), intraoperative blood transfusion (OR = 1.7), diabetes mellitus (OR = 2.7), and a transverse subcostal bilateral muscle cutting incision (OR = 3.4). There were 4 independent risk factors for pleural effusion: prolonged surgery (OR = 1), surgery on the right lobe of the liver (OR = 1.6), neoadjuvant chemotherapy (OR = 2), and a transverse subcostal bilateral muscle cutting incision (OR = 2.5). There were 3 independent risk factors for pneumonia: intraoperative blood transfusion (OR = 1.9), diabetes mellitus (OR = 2.2), and atrial fibrillation (OR = 3). For pulmonary embolism, history of previous thromboembolic events was identified as the only risk factor (OR = 8.8).
  
  
  CONCLUSIONS
  The correction of modifiable risk factors among the identified factors could reduce the incidence of PPCs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
authors.affiliation: Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre, Université de Strasbourg, Strasbourg, France.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Nobili
authors.forename: Ettore
authors.initials: E
authors.lastname: Marzano
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors