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Brocki BC, Andreasen JJ, Westerdahl E. Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level. Integr Cancer Ther 2018; 17:1095-1102. [PMID: 30136589 PMCID: PMC6247561 DOI: 10.1177/1534735418796286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objectives. To describe postoperative self-reported physical activity (PA) level and assess the effects of 2 weeks of postoperative inspiratory muscle training (IMT) in patients at high risk for postoperative pulmonary complications following lung resection. Methods. This is a descriptive study reporting supplementary data from a randomized controlled trial that included 68 patients (mean age = 70 ± 8 years), randomized to an intervention group (IG; n = 34) or a control group (CG; n = 34). The IG underwent 2 weeks of postoperative IMT added to a standard postoperative physiotherapy given to both groups. The standard physiotherapy consisted of breathing exercises, coughing techniques, and early mobilization. We evaluated self-reported physical activity (Physical Activity Scale 2.1 questionnaire) and health status (EuroQol EQ-5D-5L questionnaire), assessed the day before surgery and 2 weeks postoperatively. Results. A significant percentage of the patients in the IG reported less sedentary activity 2 weeks postoperatively when compared with the CG (sedentary 6% vs 22%, low activity 56% vs 66%, moderate activity 38% vs 12%, respectively; P = .006). The mean difference in EQ-5D-5L between the IG and CG 2 weeks postoperatively was nonsignificant (P = .80). The overall preoperative EQ-5D-5L index score for the study population was comparable to a reference population. Conclusion. Postoperative IMT seems to prevent a decline in PA level 2 weeks postoperatively in high-risk patients undergoing lung resection. More research is needed to confirm these findings.
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de Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015. Eur J Intern Med 2018; 53:66-72. [PMID: 29452729 DOI: 10.1016/j.ejim.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/29/2018] [Accepted: 02/10/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. METHODS We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. RESULTS We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p < 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). CONCLUSIONS The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD.
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Affiliation(s)
- Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Abstract
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes.
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Affiliation(s)
- Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Falk Cardiovascular Research Building, 2nd Floor, Stanford, CA 94305, USA.
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Zheng X, Huang Y, Gou J, Zhu D, Zhou Q. Concurrent thymic carcinoma and middle lobe syndrome. J Thorac Dis 2018; 10:E20-E23. [PMID: 29600097 DOI: 10.21037/jtd.2017.12.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Surgery is one of the first-line treatments for thymic carcinoma. Middle lobe syndrome which is irresponsive to conservative therapies also calls for surgical intervention. We reported the case of a 65-year-old male who was diagnosed with coexistent thymic carcinoma and non-obstructive middle lobe syndrome. Before the operation, we took measures including repeated sputum examination, physical therapy, postural sputum drainage and bronchodilator inhalation. After removal of the mediastinal neoplasm, venous antibiotics were used to prevent pneumonia. The preexistent cough with purulent expectoration still lasted, but no pulmonary infection occurred. Our report indicates that middle lobe syndrome may not increase respiratory complications after midline sternotomy if it receives proper treatments before the operation. For patients with concurrent thymic carcinoma and persistent middle lobe atelectasis, the thymic tumor might be treated with priority to increase the chance of complete resection.
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Affiliation(s)
- Xi Zheng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Yue Huang
- West China Medical School, Sichuan University, Chengdu 610041, China
| | - Junhe Gou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Daxing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
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Jung J, Moon SM, Jang HC, Kang CI, Jun JB, Cho YK, Kang SJ, Seo BJ, Kim YJ, Park SB, Lee J, Yu CS, Kim SH. Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of "Cancer POP" study. Cancer Med 2017; 7:261-269. [PMID: 29271081 PMCID: PMC5773948 DOI: 10.1002/cam4.1259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/21/2017] [Accepted: 10/13/2017] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to investigate the incidence and risk factors of postoperative pneumonia (POP) within 1 year after cancer surgery in patients with the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma [HCC]) in South Korea. This was a multicenter and retrospective cohort study performed at five nationwide cancer centers. The number of cancer patients in each center was allocated by the proportion of cancer surgery. Adult patients were randomly selected according to the allocated number, among those who underwent cancer surgery from January to December 2014 within 6 months after diagnosis of cancer. One‐year cumulative incidence of POP was estimated using Kaplan–Meier analysis. An univariable Cox's proportional hazard regression analysis was performed to identify risk factors for POP development. As a multivariable analysis, confounders were adjusted using multiple Cox's PH regression model. Among the total 2000 patients, the numbers of patients with gastric cancer, colorectal cancer, lung cancer, breast cancer, and HCC were 497 (25%), 525 (26%), 277 (14%), 552 (28%), and 149 (7%), respectively. Overall, the 1‐year cumulative incidence of POP was 2.0% (95% CI, 1.4–2.6). The 1‐year cumulative incidences in each cancer were as follows: lung 8.0%, gastric 1.8%, colorectal 1.0%, HCC 0.7%, and breast 0.4%. In multivariable analysis, older age, higher Charlson comorbidity index (CCI) score, ulcer disease, history of pneumonia, and smoking were related with POP development. In conclusions, the 1‐year cumulative incidence of POP in the five most common cancers was 2%. Older age, higher CCI scores, smoker, ulcer disease, and previous pneumonia history increased the risk of POP development in cancer patients.
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Affiliation(s)
- Jiwon Jung
- Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Song Mi Moon
- Department of Infectious Diseases, Gachon University Gil Medical Center, Incheon, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong Kyun Cho
- Department of Infectious Diseases, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Bo-Jeong Seo
- Outcomes Research/Real World Data, Corporate Affairs & Health and Value, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Young-Joo Kim
- Outcomes Research/Real World Data, Corporate Affairs & Health and Value, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Seong-Beom Park
- Medical& Scientific Affairs, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hattori K, Matsuda T, Takagi Y, Nagaya M, Inoue T, Nishida Y, Hasegawa Y, Kawaguchi K, Fukui T, Ozeki N, Yokoi K, Ito S. Preoperative six-minute walk distance is associated with pneumonia after lung resection. Interact Cardiovasc Thorac Surg 2017; 26:277-283. [DOI: 10.1093/icvts/ivx310] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/13/2017] [Indexed: 12/11/2022] Open
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Imperatori A, Nardecchia E, Dominioni L, Sambucci D, Spampatti S, Feliciotti G, Rotolo N. Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients. J Thorac Dis 2017; 9:3222-3231. [PMID: 29221299 DOI: 10.21037/jtd.2017.08.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background To assess incidence and risk factors of surgical site infections (SSI) (wound infection, pneumonia, empyema) in a monocentric series of patients undergoing lung resection over a decade. Methods All patients undergoing lung resection at our institution in 2006-2015 [wedge resection, n=579; lobectomy, n=472 (12% after chemo/radiotherapy); pneumonectomy, n=40 (47% after chemo/radiotherapy)], were prospectively enrolled. Perioperative SSI risk factors were recorded: age, gender, blood haemoglobin, lymphocyte count, serum albumin, forced expiratory volume in 1 second percentage (FEV1%) of predicted, antibiotic prophylaxis, length of stay, diabetes, malignancy, steroid therapy, induction chemo/radiotherapy, resection in 2006-2010/2011-2015, urgent/elective procedure, videothoracoscopic/open approach, resection type, operative time. SSIs diagnosed within 30 days from surgery were prospectively recorded and association with risk factors was evaluated. Results Of the 1,091 resected patients [median age, 65 (range, 13-91) years; male, 74%; malignancy, 65%], 124 (11.4%) developed one or more SSI. Wound infection, pneumonia and empyema rates were respectively 3.2%, 8.3% and 1.9%, stable through the decade. Overall infection rates after wedge resection, lobectomy and pneumonectomy were 4.8%, 17.4% and 35.0%, respectively. Thirty-day postoperative mortality was 0.6%; of the 7 deaths, 4 were causally related with SSI. Multivariable analysis showed that male gender, diabetes, preoperative steroids, induction chemo/radiotherapy, missed antibiotic prophylaxis and resection type were independent risk factors for overall SSI. Conclusions SSI rates after lung resection were stable over the decade. The observed 11.4% frequency of SSI indicates that postoperative infections remain a relevant issue and a predominant cause of mortality after lung surgery. Focusing on SSI risk factors that are perioperatively modifiable may improve surgical results.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Daniele Sambucci
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Sebastiano Spampatti
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giancarlo Feliciotti
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Li K, Xiu CL, Gao LM, Liang HG, Xu SF, Shi M, Li J, Liu ZW. Screening of specific nucleic acid aptamers binding tumor markers in the serum of the lung cancer patients and identification of their activities. Tumour Biol 2017; 39:1010428317717123. [PMID: 28718373 DOI: 10.1177/1010428317717123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Lung cancer is by far the leading cause of cancer death in the world. Despite the improvements in diagnostic methods, the status of early detection was not achieved. So, a new diagnostic method is needed. The aim of this study is to obtain the highly specific nucleic acid aptamers with strong affinity to tumor markers in the serum of the lung cancer patients for targeting the serum. Aptamers specifically binding to tumor markers in the serum of the lung cancer patients were screened from the random single-stranded DNA library with agarose beads as supports and the serum as a target by target-substituting subtractive SELEX technique and real-time quantitative polymerase chain reaction technique. Subsequently, the secondary single-stranded DNA library obtained by 10 rounds of screening was amplified to double-stranded DNA, followed by high-throughput genome sequence analysis to screen aptamers with specific affinity to tumor markers in the serum of the lung cancer patients. Finally, six aptamers obtained by 10 rounds of screening were identified with high specific affinity to tumor markers in the serum of the lung cancer patients. Compared with other five aptamers, the aptamer 43 was identified both with the highest specificity to bind target molecule and without any obvious affinity to non-specific proteins. The screened aptamers have relatively high specificity to combine tumor markers in the serum of the lung cancer patients, which provides breakthrough points for early diagnosis and treatment of lung cancer.
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Affiliation(s)
- Kun Li
- 1 College of Environment & Chemical Engineering, Yanshan University, Qinhuangdao, P.R. China
| | - Chen-Lin Xiu
- 1 College of Environment & Chemical Engineering, Yanshan University, Qinhuangdao, P.R. China
| | - Li-Ming Gao
- 2 The First Hospital of Qinhuangdao, Qinhuangdao, China
| | | | - Shu-Feng Xu
- 2 The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Ming Shi
- 1 College of Environment & Chemical Engineering, Yanshan University, Qinhuangdao, P.R. China
| | - Jian Li
- 1 College of Environment & Chemical Engineering, Yanshan University, Qinhuangdao, P.R. China
| | - Zhi-Wei Liu
- 1 College of Environment & Chemical Engineering, Yanshan University, Qinhuangdao, P.R. China
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Huang J, Lai Y, Zhou X, Li S, Su J, Yang M, Che G. Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. J Thorac Dis 2017; 9:1919-1929. [PMID: 28839990 DOI: 10.21037/jtd.2017.06.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT). METHODS A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF). RESULTS A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in ∆6-MWD (by 32.67 m, P=0.002), ∆PEF (by 14.3 L/min, P=0.001), ∆global scores (by 3.7, P=0.035); and a reduced ∆average total hospital stay (by 3.2 d, P=0.001) and ∆postoperative stay (by 3.6 d, P=0.001). With regard to PPC rate, the Combined PR Group had a somewhat lower PPC severity (grade II-V) compared to the Control Group. CONCLUSIONS This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.
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Affiliation(s)
- Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xudong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mei Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Lai Y, Su J, Wang M, Zhou K, Du H, Huang J, Che G. [Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary
Complications after Lobectomy in Patients with Stage I Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:286-92. [PMID: 27215457 PMCID: PMC5973058 DOI: 10.3779/j.issn.1009-3419.2016.05.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 随着医学技术的进步,医学检测手段的更新,体检筛查的普及以及社会健康意识的提高,越来越多的早期肺癌能够得到及时的发现并接受手术治疗,而关于患者术后并发症发生种类和高危因素的研究很少;针对Ⅰ期非小细胞肺癌(non-small cell lung cancer, NSCLC)术后并发症及其高危因素的研究,可为此类患者术后心肺相关并发症的预防、干预提供依据,并加速患者康复。 方法 回顾性分析2012年1月-2013年12月四川大学华西医院胸外科行肺叶切除的Ⅰ期NSCLC患者421例,以术后30天是否发生心肺相关并发症分为:并发症组和无并发症组。 结果 最终421例患者被纳入研究,其中64例为并发症组(15.2%, 64/421),357例为非并发症组(84.8%, 357/421)。421例患者中,发生肺部感染的比例最高(8.8%, 37/421),其他主要的并发症包括肺不张(5.9%, 25/421)、中量以上胸腔积液(5.0%, 21/421),持续性肺漏气(3.6%, 15/421)等;术前合并慢性阻塞性肺部疾病(chronic obstructive pulmonary disease, COPD)(P=0.027),术前白细胞计数(P < 0.001),中性淋巴比(neutrophil-lymphocyte ratio, NLR)(P < 0.001),术中出血量(P=0.034)以及手术时间(P=0.007)在两组间差异有统计学意义;采用二分类Logistics回归分析后发现,术前白细胞计数(OR=1.451, 95%CI: 1.212-1.736, P < 0.001)、术前合并COPD(OR=0.031, 95%CI: 0.012-0.078, P < 0.001)是术后发生心肺相关并发症的独立危险因素。 结论 术前白细胞计数以及术前合并COPD是Ⅰ期肺癌患者术后心肺相关并发症发生的独立危险因素,可能可以作为预测术后心肺相关并发症的可靠指标。
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mingming Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Heng Du
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Liu GW, Sui XZ, Wang SD, Zhao H, Wang J. Identifying patients at higher risk of pneumonia after lung resection. J Thorac Dis 2017; 9:1289-1294. [PMID: 28616280 DOI: 10.21037/jtd.2017.04.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonia is considered as one of the most common and serious complications after lung resection. The purpose of this study was to identify the risk factors associated with postoperative pneumonia (POP) after lung resection and to develop a scoring system to stratify patients with increased risk of POP. METHODS A retrospective review of a prospective database of patients between September 2014 and June 2016 was carried out. Logistic regression analysis was used to examine the risk factors for POP. Bootstrap resampling analysis was used for internal validation. Regression coefficients were used to develop weighted risk scores for POP. RESULTS Results revealed that age ≥64 years, smoking (current or previous), high pathological stage, and extent of excision of more than one lobe as risk factors. Logistic regression analysis showed that the predictors of POP were as follows: age ≥64 years, smoking, extent of excision of more than one lobe. A weighted score based on these factors was developed which was follows: smoking (three points), age ≥64 years (four points), and extent of excision of more than one lobe (five points). POP score >5 points offered the best combination of sensitivity (64.7%) and specificity (83.3%), and an area under receiver operating characteristic (ROC) curve (AUC) of 0.830 [95% confidence interval (CI): 0.746-0.914]. CONCLUSIONS Patients with older age, smoking and extent of excision of more than one lobe have a higher risk for pneumonia after lung cancer surgery. Also, the scoring system helps to guide decision making of POP risk reduction.
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Affiliation(s)
- Gan-Wei Liu
- Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xi-Zhao Sui
- Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shao-Dong Wang
- Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Hui Zhao
- Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing 100044, China
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Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, Nadhim A, Shaffiy S, Mont MA. The Epidemiology and Risk Factors for Postoperative Pneumonia. J Clin Med Res 2017; 9:466-475. [PMID: 28496546 PMCID: PMC5412519 DOI: 10.14740/jocmr3002w] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/19/2022] Open
Abstract
Postoperative pneumonia is a common complication of surgery, and is associated with marked morbidity and mortality. Despite advances in surgical and anesthetic technique, it persists as a frequent postoperative complication. Many studies have aimed to assess its burden, as well as associated risk factors. However, this complication varies among the different surgical specialties, and there is a paucity of reports that comprehensively evaluate this complication. Therefore, the purpose of this study was to review the epidemiology and risk factors of postoperative pneumonia in the setting of: 1) general surgery; 2) cardiothoracic surgery; 3) orthopedic and spine surgery; and 4) head and neck surgery.
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Chukwuweike U Gwam
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Nequesha Mohamed
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rafay Khan
- Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Ali Nadhim
- Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Shervin Shaffiy
- St. Georges University School of Medicine, True Blue, Grenada, West Indies
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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63
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Montané B, Toosi K, Velez-Cubian FO, Echavarria MF, Thau MR, Patel RA, Rodriguez K, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy. Surg Innov 2017; 24:122-132. [PMID: 28128014 DOI: 10.1177/1553350616687435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We investigated whether higher body mass index (BMI) affects perioperative and postoperative outcomes after robotic-assisted video-thoracoscopic pulmonary lobectomy. METHODS We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy by one surgeon between September 2010 and January 2015. Patients were grouped according to the World Health Organization's definition of obesity, with "obese" being defined as BMI >30.0 kg/m2. Perioperative outcomes, including intraoperative estimated blood loss (EBL) and postoperative complication rates, were compared. RESULTS Over 53 months, 287 patients underwent robotic-assisted pulmonary lobectomy, with 7 patients categorized as "underweight," 94 patients categorized as "normal weight," 106 patients categorized as "overweight," and 80 patients categorized as "obese." Because of the relatively low sample size, "underweight" patients were excluded from this study, leaving a total cohort of 280 patients. There was no significant difference in intraoperative complication rates, conversion rates, perioperative outcomes, or postoperative complication rates among the 3 groups, except for lower risk of prolonged air leaks ≥7 days and higher risk of pneumonia in patients with obesity. CONCLUSIONS Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with "normal weight" and "overweight" patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.
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Affiliation(s)
| | | | | | | | | | - Raj A Patel
- 1 University of South Florida, Tampa, FL, USA
| | | | | | | | - Jacques P Fontaine
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
| | - Eric M Toloza
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
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64
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Simonsen DF, Thomsen RW. Response to Letter to the Editor: "Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival". Respir Med 2016; 112:133. [PMID: 26809767 DOI: 10.1016/j.rmed.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Dennis Fristrup Simonsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
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65
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Cavalheri V, Hill K. Letter to the Editor: "Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival". Respir Med 2015; 112:132. [PMID: 26324316 DOI: 10.1016/j.rmed.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Physiotherapy Department, Royal Perth Hospital, GPO Box X2213, Perth, WA 6001, Australia.
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