title: Long-term impact of developing a postoperative pulmonary complication after lung surgery.
abstract: BACKGROUND
  Postoperative pulmonary complications (PPC) such as atelectasis and pneumonia are common following lung resection. PPCs have a significant clinical impact on postoperative morbidity and mortality. We studied the long-term effects of PPCs and sought to identify independent risk factors.
  
  
  METHODS
  A prospective observational study involved all patients following lung resection in a regional thoracic centre over 4 years. PPCs were assessed daily in hospital using the Melbourne group scale based on chest X-ray, white cell count, fever, purulent sputum, microbiology, oxygen saturations, physician diagnosis and intensive therapy unit (ITU)/high-dependency unit readmission. Follow-up included hospital length of stay (LOS), 30-day readmissions, and mortality.
  
  
  RESULTS
  86 of 670 patients (13%) who had undergone a lung resection developed a PPC. Those patients had a significantly longer hospital LOS in days (13, 95% CI 10.5-14.9 vs 6.3, 95% CI 5.9 to 6.7; p<0.001) and higher rates of ITU admissions (28% vs 1.9%; p<0.001) and 30-day hospital readmissions (20.7% vs 11.9%; p<0.05). Significant independent risk factors for development of PPCs were COPD and smoking (p<0.05), not age. Excluding early postoperative deaths, developing a PPC resulted in a significantly reduced overall survival in months (40, 95% CI 34 to 44 vs 46, 95% CI 44 to 47; p=0.006). Those who developed a PPC had a higher rate of non-cancer-related deaths (11% vs 5%; p=0.020). PPC is a significant independent risk factor for late deaths in non-small cell lung cancer patients (HR 2.0, 95% CI 1.9 to 3.2; p=0.006).
  
  
  CONCLUSIONS
  Developing a PPC after thoracic surgery is common and is associated with a poorer long-term outcome.
authors.affiliation: Centre for Translational Inflammation Research (CITR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Sebastian T
authors.initials: ST
authors.lastname: Lugg
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Agostini
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Theofano
authors.initials: T
authors.lastname: Tikka
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Kerr
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Adams
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Ehab
authors.initials: E
authors.lastname: Bishay
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Maninder S
authors.initials: MS
authors.lastname: Kalkat
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Steyn
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Pala B
authors.initials: PB
authors.lastname: Rajesh
authors.affiliation: Centre for Translational Inflammation Research (CITR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Thickett
authors.affiliation: Centre for Translational Inflammation Research (CITR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission / Q000639:trends; D011013:Pneumonectomy / Q000009:adverse effects*; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: COPD Pathology; Lung Cancer; Pneumonia; Thoracic Surgery; Tobacco and the lung