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Long-term impact of developing a postoperative pulmonary complication after lung surgery.

Lugg, Sebastian T and Agostini, Paula J and Tikka, Theofano and Kerr, Amy and Adams, Kerry and Bishay, Ehab and Kalkat, Maninder S and Steyn, Richard S and Rajesh, Pala B and Thickett, David R and Naidu, Babu V (2016) Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 71 (2). pp. 171-6. ISSN 1468-3296. This article is available to all HEFT staff and students via http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://thorax.bmj.com/content/71/2/171?hwoasp=auth...

Abstract

INTRODUCTION

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.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Thoracic Surgery
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Depositing User: Mrs Caroline Tranter
Date Deposited: 24 Feb 2017 10:03
Last Modified: 24 Feb 2017 10:03
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1201

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