title: Qualitative Analysis of Preoperative High-Resolution Computed Tomography: Risk Factors for Pulmonary Complications After Major Lung Resection.
abstract: BACKGROUND
  Postoperative pulmonary complications after major lung resection are strongly associated with mortality. Qualitative findings of emphysema, bronchiectasis, and bronchial wall thickening on high-resolution computed tomography (HRCT) are indicators of chronic obstructive pulmonary disease and may serve as risk factors for pulmonary complications.
  
  
  METHODS
  The subjects were 347 consecutive patients who underwent single lobectomy for pulmonary malignancy from May 2010 to December 2014. Correlations of pulmonary complications with preoperative clinical factors and HRCT findings were retrospectively examined using multivariate logistic regression analysis to compare the predictive ability for pulmonary complications using clinical variables that were reported to be risk factors.
  
  
  RESULTS
  Patients who had pulmonary complications were more frequently male (p < 0.001), with a greater smoking history (p < 0.001), lower rate of steroid use (p < 0.001), more frequent emphysema on HRCT (p < 0.001), more frequent bronchiectasis on HRCT (p = 0.002), more frequent bronchial wall thickening on HRCT (p < 0.001), and higher rate of extended resection (p = 0.006). In multivariate analysis, HRCT findings (odds ratio [OR] 12.01, 95% confidence interval [CI]: 5.582 to 25.83, p < 0.001) and extended resection (OR 7.726, 95% CI: 1.678 to 35.57, p = 0.009) were independent risk factors for pulmonary complications. After matching of risk factors between patients with and without pulmonary complication, emphysema (OR 3.394, 95% CI: 1.781 to 6.469, p < 0.001) and bronchial wall thickening (OR 6.250, 95% CI: 2.414 to 16.18, p < 0.001) were independently associated with pulmonary complications in the model with better performance.
  
  
  CONCLUSIONS
  Qualitative findings on HRCT are independent risk factors for pulmonary complications after lobectomy. Preoperative HRCT may be useful to predict pulmonary complications.
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan. Electronic address: yusuketakahashigts@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Matsuda
authors.affiliation: Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Shuri
authors.initials: S
authors.lastname: Aoki
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Dejima
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsutani
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kawamura
mesh_terms: D000368:Aged; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000453:epidemiology; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000453:epidemiology; D036301:Qualitative Research; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*