title: Risk factors and consequences of perioperative reoperation in patients undergoing pulmonary resection surgery.
abstract: BACKGROUND
  Perioperative reoperation is generally agreed to be necessary for the management of particular, severe complications. Understanding the incidence and predictors of perioperative reoperation enables surgeons to improve surgery quality. The objective of this study is to investigate the incidence, risk factors, and consequences of perioperative reoperation after pulmonary resection.
  
  
  METHODS
  Data from patients who underwent perioperative reoperation after pulmonary resection surgery over the past 6 years in our department were reviewed retrospectively. A propensity score-matched analysis was performed to identify the association between reoperation and clinical outcomes. Univariate and multivariate analysis were used to analyze independent risk factors for the occurrence of reoperation.
  
  
  RESULTS
  Overall, 19,304 patients with various lung diseases who underwent pulmonary resection surgeries were analyzed retrospectively, in which 195 patients (1.01%) required reoperation for severe perioperative complications. The leading cause for reoperation was hemorrhage in 143 (73.33%) patients, followed by bronchopleural fistula in 22 patients (11.28%). Further indications for reoperation were chyle leak, bronchial esophageal fistula, empyema, pulmonary congestion, air leak, and femoral artery embolism. The mortality of reoperation was 5.13% (10/195), with the highest (33.33%) among bronchial esophageal fistula and empyema. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion (P < .05). Logistic regression indicated that patients with comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early reoperation that performed within 24 hours (P < .05); however, operative approach showed no significance in terms of reoperation that happened beyond 24 hours (P = .087).
  
  
  CONCLUSIONS
  The incidence of perioperative reoperation after pulmonary resection surgery is low and is mainly related to technical issues from the initial operation. The most common complication is hemorrhage, and the mortality of reoperation in bronchial esophageal fistula and empyema is higher than in others. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion. Preoperative comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early perioperative reoperation that was performed within 24 hours; approach of surgery was not significant in terms of reoperation that happened beyond 24 hours.
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Gao
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China. Electronic address: yifengsun2015@163.com.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao-tong University, Shanghai, China. Electronic address: hu_dz94@hotmail.com.
authors.forename: Dingzhong
authors.initials: D
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult