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Licker M, El Manser D, Bonnardel E, Massias S, Soualhi IM, Saint-Leger C, Koeltz A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. J Clin Med 2024; 13:2765. [PMID: 38792307 PMCID: PMC11121931 DOI: 10.3390/jcm13102765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.
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Affiliation(s)
- Marc Licker
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Diae El Manser
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Eline Bonnardel
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Sylvain Massias
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Islem Mohamed Soualhi
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Charlotte Saint-Leger
- Department of Cardiovascular & Thoracic Surgery, University Hospital of Martinique, F-97200 Fort-de-France, France;
| | - Adrien Koeltz
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
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Batıhan G, Ceylan KC, Kaya ŞÖ. Risk factors and prognostic significance of early postoperative complications for patients who underwent pneumonectomy for lung cancer. J Cardiothorac Surg 2024; 19:272. [PMID: 38702724 PMCID: PMC11067157 DOI: 10.1186/s13019-024-02777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Although pneumonectomy has relatively high mortality and morbidity rates, it remains valid in the surgical treatment of lung cancer. This study aims to evaluate the prognostic significance of postoperative complications after pneumonectomy and demonstrate the risk factors related to early postoperative complications. METHODS Patients who underwent pneumonectomy for non-small cell lung cancer between January 2008 and May 2021 were included in the study. Factors related to the development of early postoperative complications and overall survival were evaluated by univariate and multivariate analyses. RESULTS A total of 136 patients were included in the study. Early postoperative complications were seen in 33 (24.3%) patients and late postoperative complications in 7 (5.1%) patients. The amount of cigarette smoking, and the operation side were the independent variables that affect the development of early postoperative complications. In multivariate analysis, smoking amount and pericardial invasion were associated with the development of postoperative hemorrhage, and advanced age was associated with the development of postoperative pneumonia. CONCLUSIONS Early postoperative complications have a negative effect on the prognosis after pneumonectomy therefore careful patient selection and preoperative risk assessment are essential to minimize the occurrence of complications and improve patient outcomes. TRIAL REGISTRATION This observational study was approved by the (Ethical Committee of Dr. Suat Seren Chest Diseases and Chest Surgery Education and Research Center) Institutional Review Board of our center (E-49109414-604.02.02-218625439).
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Affiliation(s)
- Güntuğ Batıhan
- Department of Thoracic Surgery, Kafkas University Medical Faculty, Sehitler district, Kars, 36100, Turkey.
| | - Kenan Can Ceylan
- Dr Suat Seren Chest Diseases and Chest Surgery Training, Research Hospital, University of Health Sciences Turkey, Izmir, Turkey
| | - Şeyda Örs Kaya
- Dr Suat Seren Chest Diseases and Chest Surgery Training, Research Hospital, University of Health Sciences Turkey, Izmir, Turkey
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Liu Y, Tang T, Wang C, Wang C, Zhu D. Analysis of the incidence and influencing factors of abdominal distension in postoperative lung cancer patients in ICU based on real-world data: a retrospective cohort study. BMC Surg 2024; 24:26. [PMID: 38238695 PMCID: PMC10795388 DOI: 10.1186/s12893-024-02317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Abdominal distension is a relatively common complication in postoperative lung cancer patients, which affects patients' early postoperative recovery to varying degrees. However, the current status of the incidence of abdominal distension in postoperative lung cancer patients and the affecting factors are not well understood. This study aims at exploring the incidence of abdominal distension in postoperative lung cancer patients in ICU based on real-world data and analyzing its influencing factors. METHODS A retrospective cohort study was conducted, encompassing patients who underwent lung cancer resections in the Lung Cancer Center of West China Hospital of Sichuan University from April 2020 to April 2021. Nevertheless, patients younger than 18 years and those whose information was limited in medical records were excluded. All data were obtained from the hospital HIS system. In this study, the influencing factors of abdominal distension were analyzed by univariate analysis and multiple logistic regression methods. RESULTS A total of 1317 patients met eligibility criteria, and were divided into the abdominal distended group and the non-distended group according to whether abdominal distension occurred after surgery. Abdominal distension occurred in a total of 182 cases(13.8%). The results of the univariate analysis showed that, compared with the non-distended group, the abdominal distended group had these features as follows: more women (P = 0.021), older (P = 0.000), lower BMI (P = 0.000), longer operation duration (P = 0.031), more patients with open thoracotomy (P = 0.000), more patients with pneumonectomy (p = 0.002), more patients with neoadjuvant chemotherapy (P = 0.000), more days of hospitalization on average (P = 0.000), and higher costs of hospitalization on average (P = 0.032). Multifactor logistic regression analysis showed that sex (OR = 0.526; 95% CI = 0.378 ~0.731), age (OR = 1.154; 95%CI = 1.022 ~1.304) and surgical approach (OR = 4.010; 95%CI = 2.781 ~5.781) were independent influencing factors for the occurrence of abdominal distension in patients after lung cancer surgery in ICU. CONCLUSIONS The incidence of abdominal distension was high in postoperative lung cancer patients in ICU, and female, older and patients with open thoracotomy were more likely to experience abdominal distension. TRIAL REGISTRATION The study was approved by the Chinese Clinical Trials Registry (registration number was ChiCTR2200061370).
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Affiliation(s)
- Yan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingting Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunyan Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Daxing Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Li J, Liu J, Zhang M, Wang J, Liu M, Yu D, Rong J. Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study. Brain Behav 2024; 14:e3379. [PMID: 38376027 PMCID: PMC10772846 DOI: 10.1002/brb3.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences. AIMS This study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD. METHODS A total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC). RESULTS In total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively. CONCLUSION The TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.
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Affiliation(s)
- Jianli Li
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
- Graduate FacultyHebei North UniversityZhangjiakou CityChina
| | - Mingming Zhang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Meinv Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Junfang Rong
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
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Piccioni F, Langiano N, Bignami E, Guarnieri M, Proto P, D'Andrea R, Mazzoli CA, Riccardi I, Bacuzzi A, Guzzetti L, Rossi I, Scolletta S, Comi D, Benigni A, Pierconti F, Coccia C, Biscari M, Murzilli A, Umari M, Peratoner C, Serra E, Baldinelli F, Accardo R, Diana F, Fasciolo A, Amodio R, Ball L, Greco M, Pelosi P, Della Rocca G. One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2023; 37:2561-2571. [PMID: 37730455 PMCID: PMC10133024 DOI: 10.1053/j.jvca.2023.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. DESIGN Multicenter, randomized, single-blind, controlled trial. SETTING Sixteen Italian hospitals. PARTICIPANTS A total of 880 patients undergoing elective major lung resection. INTERVENTIONS Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. MEASUREMENTS AND MAIN RESULTS ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. CONCLUSIONS In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.
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Affiliation(s)
- Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Nicola Langiano
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Guarnieri
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Paolo Proto
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rocco D'Andrea
- Department of Anesthesia, Intensive Care Medicine and Emergency, IRRCS Policlinico di Sant' Orsola, Bologna Academic Hospital, Bologna, Italy
| | - Carlo A Mazzoli
- Department of Anesthesia, Intensive Care Medicine and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Ilaria Riccardi
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Luca Guzzetti
- ASST Settelaghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Irene Rossi
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Sabino Scolletta
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Daniela Comi
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alberto Benigni
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Pierconti
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Cecilia Coccia
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Matteo Biscari
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Alice Murzilli
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Marzia Umari
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Caterina Peratoner
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Eugenio Serra
- Anesthesia and Intensive Care Medicine Institute - Azienda Ospedaliera-Università of Padua, Padua, Italy
| | | | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione G. Pascale - IRCCS, Naples, Italy
| | - Fernanda Diana
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Brotzu - Ospedale Oncologico Businco, Cagliari, Italy
| | | | - Riccardo Amodio
- Department of Anesthesia, Intensive Care and Pain Medicine, IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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Zhao D, Ma A, Li S, Fan J, Li T, Wang G. Development and validation of a nomogram for predicting pulmonary complications after video-assisted thoracoscopic surgery in elderly patients with lung cancer. Front Oncol 2023; 13:1265204. [PMID: 37901337 PMCID: PMC10613030 DOI: 10.3389/fonc.2023.1265204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Background Postoperative pulmonary complications (PPCs) significantly increase the morbidity and mortality in elderly patients with lung cancer. Considering the adverse effects of PPCs, we aimed to derive and validate a nomogram to predict pulmonary complications after video-assisted thoracoscopic surgery in elderly patients with lung cancer and to assist surgeons in optimizing patient-centered treatment plans. Methods The study enrolled 854 eligible elderly patients with lung cancer who underwent sub-lobectomy or lobectomy. A clinical prediction model for the probability of PPCs was developed using univariate and multivariate analyses. Furthermore, data from one center were used to derive the model, and data from another were used for external validation. The model's discriminatory capability, predictive accuracy, and clinical usefulness were assessed using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis, respectively. Results Among the eligible elderly patients with lung cancer, 214 (25.06%) developed pulmonary complications after video-assisted thoracoscopic surgery. Age, chronic obstructive pulmonary disease, surgical procedure, operative time, forced expiratory volume in one second, and the carbon monoxide diffusing capacity of the lung were independent predictors of PPCs and were included in the final model. The areas under the ROC curves (AUC) of the training and validation sets were 0.844 and 0.796, respectively. Ten-fold cross-validation was used to evaluate the generalizability of the predictive model, with an average AUC value of 0.839. The calibration curve showed good consistency between the observed and predicted probabilities. The proposed nomogram showed good net benefit with a relatively wide range of threshold probabilities. Conclusion A nomogram for elderly patients with lung cancer can be derived using preoperative and intraoperative variables. Our model can also be accessed using the online web server https://pulmonary-disease-predictor.shinyapps.io/dynnomapp/. Combining both may help surgeons as a clinically easy-to-use tool for minimizing the prevalence of pulmonary complications after lung resection in elderly patients.
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Affiliation(s)
- Di Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Anqun Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuang Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Jiaming Fan
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tianpei Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gongchao Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Zhang D, Xi Y, Boffa DJ, Liu Y, Nogueira LM. Association of Wildfire Exposure While Recovering From Lung Cancer Surgery With Overall Survival. JAMA Oncol 2023; 9:1214-1220. [PMID: 37498574 PMCID: PMC10375383 DOI: 10.1001/jamaoncol.2023.2144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/26/2023] [Indexed: 07/28/2023]
Abstract
Importance With a changing climate, wildfire activity in the US has increased dramatically, presenting multifaceted and compounding health hazards. Individuals discharged from the hospital following surgical resection of non-small cell lung cancer (NSCLC) are potentially at higher risk from wildfires' health hazards. Objective To assess the association between wildfire exposure and postoperative long-term overall survival among patients with lung cancer in the US. Design, Setting, and Participants In this cohort study, individuals who underwent curative-intent NSCLC resection between January 1, 2004, and December 31, 2019, were selected from the National Cancer Database. Daily wildfire information was aggregated at the zip code level from the National Aeronautics and Space Administration Fire Information for Resource Management System. The data analysis was performed between July 19, 2022, and April 14, 2023. Exposure An active wildfire detected at the zip code of residence between 0 and 3, 4 and 6, or 7 and 12 months after NSCLC surgery. Main Outcome Overall survival was defined as the interval between age at hospital discharge and age at death, last contact, or study end, whichever came first. Cox proportional hazards were used for estimating hazard ratios (HRs) adjusted for sex, region, metropolitan category, health insurance type, comorbidities, tumor size, lymph node involvement, era, and facility type. Results A total of 466 912 individuals included in the study (249 303 female and [53.4] and 217 609 male [46.6%]; mean [SD] age at diagnosis, 67.3 [9.9] years), with 48 582 (10.4%) first exposed to a wildfire between 0 and 3 months, 48 328 (10.6%) between 4 and 6 months, and 71 735 (15.3%) between 7 and 12 months following NSCLC surgery. Individuals exposed to a wildfire within 3 months (adjusted HR [AHR], 1.43; 95% CI, 1.41-1.45), between 4 and 6 months (AHR, 1.39; 95% CI, 1.37-1.41), and between 7 and 12 months (AHR, 1.17; 95% CI, 1.15-1.19) after discharge from the hospital following stage I to III NSCLC resection had worse overall survival than unexposed individuals. Conclusions In this cohort study, wildfire exposure was associated with worse overall survival following NSCLC surgical resection, suggesting that patients with lung cancer are at greater risk from the health hazards of wildfires and need to be prioritized in climate adaptation efforts.
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Affiliation(s)
- Danlu Zhang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yuzhi Xi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leticia M. Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
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Zheng S, Ye T, Li B, Zhang Y, Luo X, Hu H, Chen H. Bleeding-related re-exploration following pulmonary resection: a report of a single-center experience. J Cancer Res Clin Oncol 2023; 149:6841-6848. [PMID: 36808301 DOI: 10.1007/s00432-023-04591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Postoperative bleeding is a potentially fatal complication after lung surgery and usually requires re-operation. The aim of this study was to analyze the characteristics of bleeding-related re-exploration following pulmonary resection and reduce the incidence of this complication. METHODS From January 2016 to December 2020, 14,104 patients underwent pulmonary resection for lung cancer or pulmonary nodule at Fudan University Shanghai Cancer Center, China. We evaluated cases with bleeding-related re-exploration, and analyzed the relationship between postoperative bleeding and clinical characteristics. We further developed a protocol to reduce the proportion of bleeding-related re-exploration in our center. RESULTS Bleeding-related re-exploration occurred in 85 (0.60%) out of 14,104 patients. The sources of postoperative bleeding included surgical incision (20, 23.53%), parietal pleura (20, 23.53%), bronchial artery (14, 16.47%), lung parenchyma (13, 15.29%), pulmonary vessel (5, 5.88%) and rare source of bleeding. There were various patterns of postoperative bleeding. Open thoracotomy had a significantly higher bleeding rate than video-assisted thoracoscopic surgery (VATS) (1.27% vs 0.34%, p < 0.0001). The bleeding rate of pneumonectomy, lobectomy, segmentectomy and wedge resection was significantly different (1.78%, 0.88%, 0.46% vs 0.28%, p < 0.0001). All patients were discharged successfully except for one patient died of respiratory failure. A protocol based on these findings was developed to reduce the proportion of bleeding-related re-exploration in our center. CONCLUSION Our findings revealed that the source of bleeding, surgical approach and procedure affected the pattern of postoperative bleeding. Postoperative bleeding could be managed properly on the timely decision of re-exploration considering its origin, severity, onset and risk factors.
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Affiliation(s)
- Shanbo Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Xiaoyang Luo
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.
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Wei L, Wang Y. Efficacy of the enhanced recovery after surgery protocol in operating room nursing of patients following single-port video-assisted thoracoscopic lung cancer surgery: A retrospective study. Medicine (Baltimore) 2023; 102:e33427. [PMID: 37000065 PMCID: PMC10063301 DOI: 10.1097/md.0000000000033427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
This study assessed the efficacy of the enhanced recovery after surgery (ERAS) protocol in operating room nursing care for patients who underwent single-port video-assisted thoracoscopic lung cancer surgery. The study included 82 surgical lung cancer cases. The patients underwent single-port video-assisted thoracoscopic lung cancer surgery between April 1, 2021, and June 31, 2022. Of the 82 patients, 42 received nursing care under the ERAS protocol (experimental group) and 40 had routine nursing care (control group) in the operation room. Based on the 2 different nursing care approaches, the postoperative functional recovery efficacy, quality of life, postoperative complications, and psychological status were compared between the 2 groups. In our analysis, the mean anal venting time, average early out-of-bed time, the average time to liquid resumption, atelectasis, and pulmonary infection rate were significantly lower in the experimental group than in the control group (P < .05). The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) scores were also significantly lower in the experimental group than in the control group (P < .05). Other indicators were not significantly different between the 2 groups. Our results show that the implementation of an ERAS protocol in operating room nursing care is feasible and should be clinically applied. The ERAS protocol may enhance the recovery of patients who underwent single-port video-assisted thoracoscopic lung cancer surgery.
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Affiliation(s)
- Lijun Wei
- Department of Operation Room, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute of Life and Health Industry, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yingying Wang
- Department of Operation Room, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute of Life and Health Industry, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
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Lei SH, Guo GF, Yan T, Zhao BC, Qiu SD, Liu KX. Acute Kidney Injury After General Thoracic Surgery: A Systematic Review and Meta-Analysis. J Surg Res 2023; 287:72-81. [PMID: 36870304 DOI: 10.1016/j.jss.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/28/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The clinical importance of postoperative acute kidney injury (AKI) in patients undergoing general thoracic surgery is unclear. We aimed to systematically review the incidence, risk factors, and prognostic implications of AKI as a complication after general thoracic surgery. METHODS We searched PubMed, EMBASE, and the Cochrane Library from January 2004 to September 2021. Observational or interventional studies that enrolled ≥50 patients undergoing general thoracic surgery and reported postoperative AKI defined using contemporary consensus criteria were included for meta-analysis. RESULTS Thirty-seven articles reporting 35 unique cohorts were eligible. In 29 studies that enrolled 58,140 consecutive patients, the pooled incidence of postoperative AKI was 8.0% (95% confidence interval [CI]: 6.2-10.0). The incidence was 3.8 (2.0-6.2) % after sublobar resection, 6.7 (4.1-9.9) % after lobectomy, 12.1 (8.1-16.6) % after bilobectomy/pneumonectomy, and 10.5 (5.6-16.7) % after esophagectomy. Considerable heterogeneity in reported incidences of AKI was observed across studies. Short-term mortality was higher (unadjusted risk ratio: 5.07, 95% CI: 2.99-8.60) and length of hospital stay was longer (weighted mean difference: 3.53, 95% CI: 2.56-4.49, d) in patients with postoperative AKI (11 studies, 28,480 patients). Several risk factors for AKI after thoracic surgery were identified. CONCLUSIONS AKI occurs frequently after general thoracic surgery and is associated with increased short-term mortality and length of hospital stay. For patients undergoing general thoracic surgery, AKI may be an important postoperative complication that needs early risk evaluation and mitigation.
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Affiliation(s)
- Shao-Hui Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gao-Feng Guo
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yan
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bing-Cheng Zhao
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Da Qiu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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11
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Chen Z, Jia J, Gui D, Liu F, Li J, Tu J. Functional and postoperative outcomes after high-intensity interval training in lung cancer patients: A systematic review and meta-analysis. Front Oncol 2023; 12:1029738. [PMID: 36741720 PMCID: PMC9895778 DOI: 10.3389/fonc.2022.1029738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023] Open
Abstract
Objective The study evaluated the effects of high-intensity interval training (HIIT) on postoperative complications and lung function in patients with lung cancer compared to usual care. Methods We searched electronic databases in April 2022, including PubMed, Embase, the Cochrane Library, Web of Science, and the China National Knowledge Infrastructure (CNKI). Two authors independently applied the Cochrane Risk of Bias tool to assess the quality of RCTs. The postoperative complications, length of hospitalization, and cardiopulmonary functions from the studies were pooled for statistical analysis. Results A total of 12 randomized controlled trials were eligible for inclusion and were conducted in the meta-analysis. HIIT significantly increased VO2peak (MD = 2.65; 95% CI = 1.70 to 3.60; I2 = 40%; P <0.001) and FEV1 (MD = 0.12; 95% CI = 0.04 to 0.20; I2 = 51%; P = 0.003) compared with usual care. A subgroup analysis of studies that applied HIIT perioperatively showed significant improvement of HIIT on FEV1 (MD = 0.14; 95% CI = 0.08 to 0.20; I2 = 36%; P <0.0001). HIIT significantly reduced the incidence of postoperative atelectasis in lung cancer patients compared with usual care (RD = -0.16; 95% CI = -0.24 to -0.08; I2 = 24%; P <0.0001). There was no statistically significant effect of HIIT on postoperative arrhythmias (RD = -0.05; 95% CI = -0.13 to 0.03; I2 = 40%; P = 0.22), length of hospitalization (MD = -1.64; 95% CI = -3.29 to 0.01; P = 0.05), and the six-minute walk test (MD = 19.77; 95% CI = -15.25 to 54.80; P = 0.27) compared to usual care. Conclusion HIIT may enhance VO2peak and FEV1 in lung cancer patients and reduce the incidence of postoperative atelectasis. However, HIIT may not reduce the incidence of postoperative arrhythmia, shorten the length of hospitalization, or improve the exercise performance of patients with lung cancer. Systematic review registration PROSPERO, CRD42022335441.
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Affiliation(s)
- Zihao Chen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Junqiang Jia
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Dongmei Gui
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Feng Liu
- Department of Gastroenterology, Jining No. 1 People’s Hospital, Jining, China
| | - Jun Li
- Training Department, Nanjing Sport Institute, Nanjing, China
| | - Jiayuan Tu
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China,*Correspondence: Jiayuan Tu,
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12
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Okamoto T, Matsuki Y, Ogata H, Okutani H, Ueki R, Kariya N, Tatara T, Hirose M. Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery. Interact Cardiovasc Thorac Surg 2022; 35:6754818. [PMID: 36214634 PMCID: PMC9725181 DOI: 10.1093/icvts/ivac258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II. METHODS In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade <II and ≥II. Uni- and multivariable analyses were performed to identify intraoperative risk factors. RESULTS After univariable analysis between patients with Clavien-Dindo grade <II (n = 415) and ≥II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001). CONCLUSIONS Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.
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Affiliation(s)
- Takuma Okamoto
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Yuka Matsuki
- Department of Anaesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Fukui, Japan
| | - Hiroki Ogata
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Hiroai Okutani
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Ryusuke Ueki
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Nobutaka Kariya
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Tsuneo Tatara
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Munetaka Hirose
- Corresponding author. Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501, Japan. Tel: +81-798-45-6392; fax: +81-798-45-6393; e-mail: (M. Hirose)
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13
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Inafuku K, Sekine A, Arai H, Hagiwara E, Komatsu S, Iwasawa T, Misumi T, Kikunishi N, Tajiri M, Okudela K, Rino Y, Ogura T. Radiological unilateral pleuroparenchymal fibroelastosis as a notable late complication after lung cancer surgery: incidence and perioperative associated factors. Interact Cardiovasc Thorac Surg 2022; 35:6673152. [PMID: 35993903 PMCID: PMC9487195 DOI: 10.1093/icvts/ivac223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by pleural-parenchymal involvement, predominantly in the upper lobes. Unilateral upper lung field pulmonary fibrosis (upper-PF) that is radiologically consistent with PPFE reportedly develops after lung cancer surgery in the operated side and presents many clinical characteristics in common with PPFE. However, the incidence and perioperative associated factors remain unclear.
METHODS
All consecutive patients with lung cancer resected completely from 2008 to 2016 were investigated retrospectively. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated using competing risk analysis.
RESULTS
Among the 587 included patients, 25 patients (4.3%) were diagnosed as unilateral upper-PF. The 3-, 5- and 10-year cumulative incidence of unilateral upper-PF was 2.3%, 3.3% and 5.3%, respectively. In multivariable analysis, male sex, presence of a pulmonary apical cap, lobar resection and low % vital capacity (%VC < 80%) were independent perioperative associated factors. The 10-year cumulative incidence was 6.3% in patients treated with lobar resection, 8.0% in male patients, 10.3% in patients with pulmonary apical cap and 14.5% in patients with low %VC. Postoperative pleural effusion at 6 months after surgery was much more common in the patients who later developed unilateral upper-PF (96.0% vs 24.2%). This pleural effusion persisted and was accompanied thereafter by pleural thickening and subpleural pulmonary fibrosis. During the clinical courses of 25 patients with unilateral upper-PF, 18 patients presented symptoms related to upper-PF and 6 patients died.
CONCLUSIONS
Unilateral upper-PF is an occasional but under-recognized late complication after lung cancer surgery.
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Affiliation(s)
- Kenji Inafuku
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Hiromasa Arai
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine , Yokohama, Japan
| | - Noritake Kikunishi
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Michihiko Tajiri
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Koji Okudela
- Department of pathology, Yokohama City University School of Medicine , Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University School of Medicine , Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
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14
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Tseng JH, Bristow RE. Complications associated with cytoreductive surgery for advanced ovarian cancer: Surgical timing and surmounting obstacles. Gynecol Oncol 2022; 166:5-7. [PMID: 35725134 DOI: 10.1016/j.ygyno.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jill H Tseng
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, USA
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Yang Q, Wang J, Chen Y, Lian Q, Shi Z, Zhang Y. Incidence and risk factors of postoperative delirium following total knee arthroplasty: A retrospective Nationwide Inpatient Sample database study. Knee 2022; 35:61-70. [PMID: 35220134 DOI: 10.1016/j.knee.2022.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/21/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after primary total knee arthroplasty (TKA) has not been well studied using a large-scale national database. METHODS A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent primary TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of payer, in-hospital mortality, and perioperative complications were evaluated. RESULTS A total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008.Patients with delirium after TKA presented increased comorbidities, LOS, hospital charges, usage of medicare, and in-hospital mortality (P < 0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease, pulmonary circulation disorders, peripheral vascular disorders, chronic renal failure, and teaching hospital. Notably, neurological disorders were found to have the strongest association with the occurrence of postoperative delirium. CONCLUSION A relatively low incidence of delirium after TKA was identified. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.
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Affiliation(s)
- Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuhang Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Qiang Lian
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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YAKŞİ O, KILIÇGÜN A, ERSEN E, SARBAY İ, ÜNAL M, TURNA A, KAYNAK K. Effect of complications on survival after lung cancer surgery. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.980951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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Stephens J, Tano R. Hemoglobin matters: Perioperative blood management for oncology patients. Can Oncol Nurs J 2021; 31:399-404. [PMID: 34786458 DOI: 10.5737/23688076314399404] [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: 11/05/2022] Open
Abstract
As the number of cancer cases rise each year in Canada, so does the number of surgical oncology cases. Surgery presents a unique and heightened stressor for the body already experiencing volatility from factors such as disease and treatments. Perioperative red blood cell (RBC) transfusions are critical to stabilize hemoglobin levels and correct anemia, as well as provide a buffer against anticipated intraoperative blood loss. Thoroughly examining and anticipating risk factors related to the potential need for perioperative blood transfusions is necessary to improve outcomes. Research evidence in recent years related to perioperative blood management of oncology patients has specifically recommended active, coordinated programs to reduce the need and amount of blood transfusions administered pre-, intra-, and post-surgery. Coordination between surgical oncologists and a local or provincial patient blood management (PBM) program is an important strategy that allows patients at risk of perioperative complications to be identified and receive early interventions and ongoing observation.
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Affiliation(s)
- Jennifer Stephens
- Assistant Professor and BN Program Director, Faculty of Health Disciplines, Athabasca University, Athabasca, AB
| | - Ruby Tano
- Patient Blood Management Coordinator, Patient Blood Management Program, Sunnybrook Health Sciences Centre, Toronto, ON
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18
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Stephens J, Tano R. L’importance de l’hémoglobine : gestion périopératoire du sang pour les patients en oncologie. Can Oncol Nurs J 2021; 31:405-411. [PMID: 34786459 DOI: 10.5737/23688076314405411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Au Canada, le nombre de cas de cancer augmente chaque année et, par conséquent, le nombre de patients en oncologie qui subissent une opération. La chirurgie cause un stress particulièrement intense à l’organisme déjà fragilisé par la maladie et les traitements. Les transfusions périopératoires de globules rouges sont essentielles pour stabiliser le taux d’hémoglobine et soigner l’anémie, ainsi que pour gérer la perte de sang attendue pendant l’opération. Il est nécessaire d’examiner en profondeur et d’anticiper les facteurs de risque associés aux transfusions sanguines périopératoires pour améliorer le devenir des patients. Ces dernières années, la recherche sur la gestion périopératoire du sang des patients en oncologie recommande tout spécialement la création de programmes d’intervention coordonnés pour réduire la nécessité et le nombre de transfusions sanguines administrées avant, pendant et après l’opération. Pour recenser les patients à risque de complications périopératoires et leur faire bénéficier d’interventions rapides et d’une observation continue, la bonne stratégie est de mettre en lien les chirurgiens oncologues avec un programme local ou provincial de conservation du sang.
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Affiliation(s)
- Jennifer Stephens
- Professeure adjointe et Associate Dean Undergraduate Programs, Faculté des disciplines de la santé, Université d'Athabasca, Athabasca, Alberta
| | - Ruby Tano
- Coordonnatrice de la gestion du sang des patients, Programme de gestion du sang des patients, Centre des sciences de la santé Sunnybrook, Toronto, Ontario
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19
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Saito T, Murakawa T, Shintani Y, Okami J, Miyaoka E, Yoshino I, Date H. Preoperative renal dysfunction and long-term survival after surgery for non-small cell lung cancer. J Thorac Cardiovasc Surg 2021; 164:227-239.e6. [PMID: 34600766 DOI: 10.1016/j.jtcvs.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/31/2021] [Accepted: 09/03/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the association of preoperative renal dysfunction and long-term outcomes following lung cancer surgery. METHODS Using the Japanese Lung Cancer Registry data, we retrospectively examined 16,377 patients who underwent surgery for non-small cell lung cancer during 2010. Patients' renal function status was categorized as follows: serum creatinine <1.5 mg/dL (control, n = 16,169), serum creatinine ≥1.5 mg/dL with no dialysis (nondialysis-dependent chronic kidney disease, n = 113), and dialysis-dependent end-stage renal disease (n = 95). The association of patients' characteristics with overall survival was evaluated using multivariate Cox proportional hazard model. RESULTS The 5-year overall survival rates in patients with dialysis-dependent end-stage renal disease and with nondialysis-dependent chronic kidney disease were significantly worse than that in the control group (52.9% and 57.5% vs 78.0%; P < .001 for both comparisons), but were comparable to the reported 5-year overall survival rates in the natural history of end-stage renal disease (∼60%) and moderate to severe chronic kidney disease (∼50%). Cancer causes not related to lung cancer accounted for 62.2% of deaths in dialysis-dependent end-stage renal disease, which was more frequent than that in the control group (P = .002). Dialysis-dependent end-stage renal disease and nondialysis-dependent chronic kidney disease were independent risk factors for overall survival after lung cancer surgery (hazard ratio, 2.05 [P < .001] and hazard ratio, 2.04 [P = .001], respectively). CONCLUSIONS Preoperative renal dysfunction may be adversely associated with overall survival after lung cancer surgery. Our findings could aid patients to set proper expectation of the risks and benefits about surgery for lung cancer.
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Affiliation(s)
- Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan.
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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20
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Wei X, Yu H, Dai W, Xu W, Yu Q, Pu Y, Wang Y, Liao J, Li Q, Shi Q. Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery. Support Care Cancer 2021; 30:1169-1179. [PMID: 34448942 DOI: 10.1007/s00520-021-06506-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients who undergo surgery for lung cancer experience a variety of symptoms, such as pain and coughing, which interfere with their postoperative daily functions. However, there may be differences between the perception of symptoms among healthcare providers and patients. This study aimed to investigate patients' experiences after lung cancer surgery and analyze whether the perception of postoperative symptoms among the healthcare providers differed from that reported by patients. METHODS Semi-structured qualitative interviews involving 39 patients who underwent lung cancer surgery at the Sichuan Cancer Hospital were conducted between November 2018 and October 2019. In addition, 22 healthcare providers from the Department of Thoracic Surgery at the hospital answered open-ended questions about their perception of symptoms related to lung cancer surgery. The types and frequencies of symptoms reported by the patients and healthcare providers were compared. RESULTS The most frequent patient-reported symptoms were pain (967 times, 39 patients, 100%), coughing (904 times, 37 patients, 94.87%), shortness of breath (491 times, 35 patients, 89.74%), Disturbed sleep (412 times, 34 patients, 87.18%), and interference while walking (347 times, 36 patients, 92.31%). Of the patient-reported symptoms, the first four were perceived by the healthcare providers, while they interpreted interference while walking as fatigue. CONCLUSION Although the healthcare providers and patients had a certain consensus on the main symptoms, there were differences in perception. Healthcare providers need to pay more attention to postoperative interference while walking.
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Affiliation(s)
- Xing Wei
- Department of Thoracic Surgery, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Wei Dai
- Department of Thoracic Surgery, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qingsong Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yang Pu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yaqin Wang
- Department of Thoracic Surgery, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jia Liao
- Department of Thoracic Surgery, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuling Shi
- Center for Cancer Prevention Research, School of Medicine, Sichuan Cancer Hospital, University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Road, Chengdu, 610041, China.
- State Key Laboratory of Ultrasound Engineering in Medicine, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
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21
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Zhao X, Wang M, Sun Z, Zhuang S, Zhang W, Yang Z, Han X, Nie S. MicroRNA-139-5p improves sepsis-induced lung injury by targeting Rho-kinase1. Exp Ther Med 2021; 22:1059. [PMID: 34434273 PMCID: PMC8353635 DOI: 10.3892/etm.2021.10493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/24/2021] [Indexed: 02/03/2023] Open
Abstract
Sepsis-induced acute lung injury (ALI) is an inflammatory process that involves inflammatory cytokine production and cell apoptosis. In the present study, the regulatory role of microRNA (miR)-139-5p in sepsis-induced ALI was investigated using a murine model of cecal ligation puncture (CLP) and an in vitro model using lipopolysaccharide (LPS)-induced normal human bronchial epithelial cells (NHBEs). Sepsis-induced pathological changes in the lungs of ALI mice were detected using hematoxylin and eosin staining. Lung water content was determined, and the expression of proinflammatory cytokines in the bronchoalveolar lavage fluid and serum of sepsis-induced ALI mice were quantified using ELISA. The levels of oxidative stress in lung tissues were determined using commercial kits. The degree of apoptosis was determined using a TUNEL assay. The expression levels of miR-139-5p and Rho-kinase 1 (ROCK1) were determined using reverse transcription-quantitative PCR and western blot analyses. A dual-luciferase reporter assay was used to confirm the direct targeting of ROCK1 by miR-139-5p. NHBEs were co-transfected with vectors expressing ROCK1 (or empty vector) and miR-139-5p mimics or control mimics prior to LPS treatment. The transcriptional activity of caspase-3, the ratio of apoptotic cells, the expression levels of mucin 5AC, mucin 1, TNF-α, IL-1β, IL-6, NLR family pyrin domain containing 3, apoptosis-associated speck-like protein containing a CARD and caspase-1 were evaluated. Compared with the normal group, mice that underwent CLP exhibited abnormal lung morphology, enhanced production of TNF-α, IL-1β and IL-6, increased reactive oxygen species (ROS), malondialdehyde and lactate dehydrogenase levels, an increased proportion of apoptotic cells and increased ROCK1 expression. Superoxide dismutase, glutathione peroxidase and miR-139-5p levels were decreased following CLP. In the NHBEs, stimulation with LPS caused a marked increase in inflammatory cytokine levels and apoptosis compared with the untreated cells. Overexpression of miR-139-5p attenuated cell apoptosis and inflammation. Overexpression of ROCK1 in NHBEs restored the ROS levels and proinflammatory cytokine production inhibited by miR-139-5p. In conclusion, miR-139-5p alleviated sepsis-induced ALI via suppression of its downstream target, ROCK1, suggesting that miR-139-5p may hold promise in the treatment of sepsis-induced ALI.
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Affiliation(s)
- Xinmin Zhao
- Department of Emergency Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, P.R. China.,Department of Anesthesiology, Yancheng Maternity and Child Health Hospital, Yancheng, Jiangsu 224002, P.R. China
| | - Mengmeng Wang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Zhaorui Sun
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Suyuan Zhuang
- Department of Emergency Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, P.R. China
| | - Wei Zhang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Zhizhou Yang
- Department of Emergency Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, P.R. China.,Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Xiaoqin Han
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Shinan Nie
- Department of Emergency Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, P.R. China.,Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China
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22
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Gabryel P, Piwkowski C, Kasprzyk M, Zieliński P, Roszak M, Dyszkiewicz W. Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer. Interact Cardiovasc Thorac Surg 2021; 32:356-363. [PMID: 33221893 DOI: 10.1093/icvts/ivaa274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment. METHODS This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan-Meier method. RESULTS Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions (P < 0.001) and mediastinal lymph node metastases (P < 0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3 days, P < 0.001) and hospital stay (8 vs 6 days, P < 0.001); more frequent complications (38.1% vs 27.1%, P = 0.018), including red blood cell transfusion (10.5% vs 2%, P < 0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P = 0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P = 0.014). Conversion did not increase in-hospital mortality. CONCLUSIONS Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Zieliński
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Dyszkiewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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23
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Łochowski M, Łochowska B, Chałubińska-Fendler J, Zawadzka I, Rębowski M, Kozak J. Prognostic Factors Determining Survival of Patients Operated for Non-Small Cell Lung Cancer with Consideration Given to Morphological Parameters of Blood. Cancer Manag Res 2021; 13:479-487. [PMID: 33500661 PMCID: PMC7822080 DOI: 10.2147/cmar.s280252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/28/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Prognostic biomarkers are the area of high interest in non-small cell lung cancer (NSCLC). Inflammatory blood markers can be routinely determined from complete blood counts which are inexpensive and reliable. The aim of the study was to determine prognostic parameters which, in early diagnostics, best determine survival of patients, operated on due to NSCLC. Materials The study was conducted on 532 (174 females and 358 males) patients, operated on due to NSCLC, in stages IA – III, aged 36–84 years (the mean age: 63.6 years). The following parameters were subjected to a statistical analysis, conducted in order to determine prognostic values of the number of leukocytes, neutrophils, monocytes, platelets, haemoglobin, RDW-CV and MCV, calculated values of PLR, NLR, and LMR ratios, age, sex, smoking, histopathological diagnosis, T stage, N stage, the Charlson Comorbidity Index (CCI), type of surgery, and potential complications. Results The univariate analysis revealed an impact of NLR, PLR, and LMR values, RDW-CW and CCI ranges, and also the number of monocytes on patients’ overall survival (OS). The multivariate analysis identified six independent negative prognostic factors: male sex (0.001), CCI > 4 (p=0.000007), RDW-CV > 14.5% and PLR > 144 (p=0.000001, p= 0.001, respectively), the number of metastatic N2 lymphatic nodes (p=0.0003), and existence of post-operative complications (p=0.008). Conclusion Patients’ sex, RDW and PLR values, Charlson index, the number of involved N2 nodes by cancer and postoperative complications are independent and significant prognostic factors in patients operated on due to NSCLC.
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Affiliation(s)
- Mariusz Łochowski
- Clinic of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, Lodz, Poland
| | - Barbara Łochowska
- Department of Radiotherapy and General Oncology, Regional Multi-Specialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, Lodz, Poland
| | | | - Izabela Zawadzka
- "Synevo" Medical Laboratory, Regional Multi-Specialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, Lodz, Poland
| | - Marek Rębowski
- Clinic of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, Lodz, Poland
| | - Józef Kozak
- Clinic of Thoracic Surgery and Respiratory Rehabilitation, Medical University of Lodz, Regional Multi-Specialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, Lodz, Poland
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24
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Cho S, Kang E, Kim JE, Kang U, Kang HG, Park M, Kim K, Kim DK, Joo KW, Kim YS, Yoon HJ, Lee H. Clinical Significance of Acute Kidney Injury in Lung Cancer Patients. Cancer Res Treat 2021; 53:1015-1023. [PMID: 33494125 PMCID: PMC8524013 DOI: 10.4143/crt.2020.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/17/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Acute kidney injury (AKI) in cancer patients is associated with increased morbidity and mortality. The incidence of AKI in lung cancer seems to be relatively higher compared with other solid organ malignancies, although its impact on patient outcomes remains unclear. Materials and Methods The patients newly diagnosed with lung cancer from 2004 to 2013 were enrolled in this retrospective cohort study. The patients were categorized according to the presence and severity of AKI. We compared all-cause mortality and long-term renal outcome according to AKI stage. Results A total of 3,202 patients were included in the final analysis. AKI occurred in 1,783 (55.7%) patients during the follow-up period, with the majority having mild AKI stage 1 (75.8%). During the follow-up of 2.6±2.2 years, total 1,251 patients (53.7%) were died and 5-year survival rate was 46.9%. We found that both AKI development and severity were independent risk factors for all-cause mortality in lung cancer patients, even after adjustment for lung cancer-specific variables including the stage or pathological type. In addition, patients suffered from more severe AKI tend to encounter de novo chronic kidney disease development, worsening kidney function, and end-stage kidney disease progression. Conclusion In this study, more than half of the lung cancer patients experienced AKI during their diagnosis and treatment period. Moreover, AKI occurrence and more advanced AKI were associated with a higher mortality risk and adverse kidney outcomes.
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Affiliation(s)
- Semin Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Eun Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - U Kang
- Department of Computer Science and Engineering, Seoul National University College of Engineering, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Park
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Jin Yoon
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Biomedical Engineering, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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25
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Red blood cell transfusions and the survival in patients with cancer undergoing curative surgery: a systematic review and meta-analysis. Surg Today 2021; 51:1535-1557. [PMID: 33389174 DOI: 10.1007/s00595-020-02192-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023]
Abstract
Allogenic red blood cell transfusions exert a potential detrimental effect on the survival when delivered to cancer patients undergoing surgery with curative intent. We performed a systematic review and meta-analysis to assess the association between perioperative allogenic red blood cell transfusions and risk of death as well as relapse after surgery for localized solid tumors. PubMed, the Cochrane Library, and EMBASE were searched from inception to March 2019 for studies reporting the outcome of patients receiving transfusions during radical surgery for non-metastatic cancer. Risk of death and relapse were pooled to provide an adjusted hazard ratio with a 95% confidence interval [hazard ratio (HR) (95% confidence interval {CI})]. Mortality and relapse associated with perioperative transfusion due to cancer surgery were evaluated among participants (n = 123 studies). Overall, RBC transfusions were associated with an increased risk of death [HR = 1.50 (95% CI 1.42-1.57), p < 0.01] and relapse [HR = 1.36 (95% CI 1.26-1.46), p < 0.01]. The survival was reduced even in cancer at early stages [HR = 1.45 (1.36-1.55), p < 0.01]. In cancer patients undergoing surgery, red blood cell transfusions reduced the survival and increased the risk of relapse. Transfusions based on patients' blood management policy should be performed by applying a more restrictive policy, and the planned preoperative administration of iron, if necessary, should be pursued.
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26
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Smit MA, Philipsen MW, Postmus PE, Putter H, Tollenaar RA, Cohen D, Mesker WE. The prognostic value of the tumor-stroma ratio in squamous cell lung cancer, a cohort study. Cancer Treat Res Commun 2020; 25:100247. [PMID: 33249210 DOI: 10.1016/j.ctarc.2020.100247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The tumor-stroma ratio (TSR) is based on the relative amount of stroma in the primary tumor and has proven to be an independent prognostic factor in various solid tumors. The prognosis of patients and adjuvant treatment decision making in lung squamous cell carcinomas (SqCC) is based on the TNM classification. Currently, no other prognostic biomarkers are available. In this study we evaluated the prognostic value of the TSR in lung SqCC. MATERIAL AND METHODS Patients undergoing lung surgery because of lung SqCC between 2000 and 2018 at the Leiden University Medical Center were included. The TSR was scored on hematoxylin & eosin stained tissue sections. Based on the amount of tumor-stroma, two groups were defined: ≤50% was classified as a stroma-low tumor and >50% as stroma-high. The prognostic value of the TSR was determined with survival analysis. RESULTS A total of 174 stage I-III patients were included. Of them, 79 (45%) were stroma-low and 95 (55%) stroma-high. Separately analyzed for tumor stages, the TSR showed to be an independent prognostic biomarker in stage II (n = 68) for 5-year overall survival (HR=3.0; 95% CI, 1.1-8.6; p = 0.035) and 5-year disease free survival (DFS) (HR=3.6; 95% CI, 1.3-9.9; p = 0.014). Patients with a stroma-high tumor had a worse 5-year DFS in the whole cohort (HR 1.6; 95% CI, 1.0-2.4; p = 0.048), but no independent prognostic value was found. CONCLUSION In stage II lung SqCC patients, stroma-low tumors have a better prognosis compared to stroma-high tumors. Moreover, adjuvant chemotherapy could be spared for these stroma-low patients.
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Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mark Wh Philipsen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob Aem Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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27
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Costs Associated With Lobectomy for Lung Cancer: An Analysis Merging STS and Medicare Data. Ann Thorac Surg 2020; 111:1781-1790. [PMID: 33188754 DOI: 10.1016/j.athoracsur.2020.08.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Costs related to care of patients who undergo lobectomy for lung cancer may vary depending on patient, disease, and treating facility characteristics. We aimed to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer. METHODS The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for lobectomy for clinical stage I lung cancer (2008-2013). Demographics, clinical outcomes, and 90-day episode-of-care costs across all care settings were analyzed for patients successfully linked to Medicare data. Hospital costs were estimated from charges using cost-to-charge ratios. Comprehensive regression models were created to identify impact of preoperative patient factors and hospital characteristics on costs, and to delineate additive costs due to perioperative outcomes and complications. RESULTS The mean 90-day cost for lobectomy was $45,080 ± $38,239. Variables associated with significant additive costs were age greater than or equal to 75 years, American Society of Anesthesiologists classification III or IV, forced expiratory volume in 1 second less than 80% predicted, body mass index less than 18.5 or greater than 35, current or past smoker, cerebrovascular disease, chronic kidney disease, impaired functional status, open thoracotomy, prolonged operative time, government hospitals, metropolitan setting, and geographic location. Patients with 1 or more postoperative complication resulted in an overall mean added cost of $27,259. Added costs increased with the number of complications; isolated recurrent laryngeal nerve paresis ($3,911) and respiratory failure ($35,011) were associated with the least and most additive cost, respectively. CONCLUSIONS Lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
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28
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Cowper PA, Feng L, Kosinski AS, Tong BC, Habib RH, Putnam JB, Onaitis MW, Furnary AP, Wright CD, Jacobs JP, Fernandez FG. Initial and Longitudinal Cost of Surgical Resection for Lung Cancer. Ann Thorac Surg 2020; 111:1827-1833. [PMID: 33031776 DOI: 10.1016/j.athoracsur.2020.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The longitudinal cost of treating patients with non-small cell lung cancer (NSCLC) undergoing surgical resection has not been evaluated. We describe initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or greater who were treated surgically between 2008 and 2013. METHODS Using clinical data for NSCLC resections from The Society of Thoracic Surgeons General Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined ($2017). Cost of hospital-based care was estimated using cost-to-charge ratios; professional services and care in other settings were valued using reimbursements. Inverse probability weighting was used to account for administrative censoring. Outcomes were stratified by pathologic stage and by surgical approach for stage I lobectomy patients. RESULTS Resection hospitalizations averaged 6 days and cost $31,900. In the first 90 days, costs increased with stage ($12,430 for stage I to $26,350 for stage IV). Costs then declined toward quarterly means more similar among stages. Cumulative costs ranged from $131,032 (stage I) to $205,368 (stage IV). In the stage I lobectomy cohort, patients selected for minimally invasive procedures had lower 4-year costs than did thoracotomy patients ($120,346 versus $136,250). CONCLUSIONS The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of postoperative intensive care and earlier detection and treatment of disease.
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Affiliation(s)
| | | | | | - Betty C Tong
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joe B Putnam
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | | | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Felix G Fernandez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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29
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Wang J, Xue H, Zhu Z, Gao J, Zhao M, Ma Z. Expression of serum exosomal miR-23b-3p in non-small cell lung cancer and its diagnostic efficacy. Oncol Lett 2020; 20:30. [PMID: 32774503 DOI: 10.3892/ol.2020.11891] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
The present study aimed to investigate the expression of serum exosomal miR-23b-3p in non-small cell lung cancer (NSCLC) and to determine its diagnostic efficacy for NSCLC. From October, 2017 to October, 2019, 80 patients with NSCLC, 60 patients with pneumonia and 30 healthy subjects undergoing physical examination were enrolled at the People's Hospital of Yangzhong City. Serum samples were collected from the 3 groups of patients. The expression of miR-23b-3p in exosomes was detected by RT-qPCR. The Chi-squared test was used to analyze the expression level of miR-23b-3p in exosomes, and the patients with NSCLC were divided into 2 groups according to the expression level. The association between the patient clinicopathological parameters and receiver operating characteristic (ROC) curves was used to evaluate the diagnostic efficacy of serum exosomal miR-23b-3p in NSCLC. The expression level of serum exosomal miR-23b-3p in the patients with NSCLC was significantly higher than that in patients with pneumonia (t=10.332, P<0.001) and healthy subjects (t=12.810, P<0.001); serum exosomal miR-23b-3p was significantly associated with tumor size, depth of invasion, liver metastasis and TNM stage (P<0.05). The area under the curve (AUC) for miR-23b-3p was 0.915 (95% CI, 0.84-0.92), the optimal relative expression of miR-23b-3p was 3.46, the sensitivity of diagnosis was 87.4%, and the specificity was 93.8%, all higher than that of carcinoembryonic antigen (CEA). The ROCAUC of NSCLC was 0.645 (95% CI, 0.641-0.772) and for Cyfra21-1 it was 0.745 (95% CI, 0.701-0.812). Compared with the patients with pneumonia and the healthy subjects, the patients with NSCLC exhibited a higher level of serum exosomal miR-23b-3p. On the whole, these findings indicate that miR-23b-3p has a higher clinical diagnostic efficacy and may thus be a potential biomarker for the early diagnosis of NSCLC.
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Affiliation(s)
- Jianping Wang
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
| | - Hengchuan Xue
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
| | - Zonghai Zhu
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
| | - Jie Gao
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
| | - Zhenkai Ma
- Department of Thoracic Surgery, People's Hospital of Yangzhong City, Yangzhong, Jiangsu 212200, P.R. China
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30
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Barnes JH, Orbelo DM, Armstrong MF, Bayan SL, Lohse CM, Ekbom DC. Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty. Ann Otol Rhinol Laryngol 2020; 129:1129-1134. [DOI: 10.1177/0003489420933650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Recurrent laryngeal nerve injury is a potential complication of cardiothoracic surgery and cause of unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is an intervention offered to patients with UVFP to alleviate symptoms including dysphagia, dysphonia and weak cough. There is no definitive evidence that IL prevents pneumonia. In this study, we compare rates of pneumonia in patients with UVFP secondary to cardiothoracic surgery who did or did not undergo IL. Methods: A retrospective chart review identified patients diagnosed with UVFP by an otolaryngologist using flexible laryngoscopy following cardiothoracic surgery from January 1, 2008 to December 31, 2017. Each subject was grouped by IL status and assessed for subsequent pneumonia within 6 months of their diagnosis of UVFP. The association of IL with pneumonia was evaluated using Cox proportional hazards regression. Results: Of 92 patients who met inclusion criteria, 35 (38%) underwent IL and 57 (62%) did not. Twenty patients developed pneumonia, four who had undergone IL and 16 who had not; 12 patients developed aspiration pneumonia including two having undergone IL and 10 who had not. Those who had IL were less likely to develop total pneumonia compared to those who had not (HR = 0.33, P = .045). The protective effect of IL was not as clearly sustained when measuring for aspiration pneumonia, specifically (HR = 0.34; P = .10). Discussion: Injection laryngoplasty may reduce the risk of pneumonia in patients with UVFP secondary to cardiothoracic surgery; however, further research is needed to quantify the potential protective nature of IL in this patient population. Level of evidence: 3 (A retrospective cohort study).
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Affiliation(s)
- Jason H. Barnes
- Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Diana M. Orbelo
- Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael F. Armstrong
- Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Semirra L. Bayan
- Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dale C. Ekbom
- Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Mewhort HEM, Ramakrishna H. The Society of Thoracic Surgeons General Thoracic Surgery Database: Research Applications and Results. J Cardiothorac Vasc Anesth 2020; 34:2297-2298. [PMID: 32360004 DOI: 10.1053/j.jvca.2020.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Holly E M Mewhort
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN
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Li C, Lei Z, Peng B, Zhu J, Chen L. LncRNA HCP5 Stimulates the Proliferation of Non-Small Cell Lung Cancer Cells by Up-Regulating Survivin Through the Down-Regulation of miR-320. Cancer Manag Res 2020; 12:1129-1134. [PMID: 32104093 PMCID: PMC7028385 DOI: 10.2147/cmar.s222221] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/10/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction We explored the roles of lncRNA HCP5 in non-small cell lung cancer (NSCLC). Methods Levels of HCP5 were measured by performing qPCR and data were compared between non-tumor and NSCLC tissue samples by performing a paired t-test. Expression levels of miR-320 and survivin mRNA in NSCLC tissues were also measured by performing qPCR. The effects of HCP5, miR-320 and survivin overexpression on the proliferation of H23 cells were analyzed by cell proliferation assay. Results We found that HCP5 was up-regulated in NSCLC and predicted the poor survival of NSCLC patients. HCP5 was negatively correlated with miR-320 but positively correlated with survivin in NSCLC tissues. In NSCLC cells, HCP5 overexpression led to the up-regulated survivin and down-regulated miR-320. Moreover, miR-320 overexpression failed to affect HCP5 but down-regulated survivin. Cell proliferation assay showed that HCP5 and survivin overexpression led to increased, while miR-320 overexpression led to decreased cell proliferation rate. In addition, miR-320 overexpression reduced the effects of HCP5 overexpression. Conclusion Therefore, HCP5 may stimulate the proliferation of NSCLC cells by up-regulating survivin through the down-regulation of miR-320.
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Affiliation(s)
- Chao Li
- Oncology Department, Second People's Hospital of Jingmen, Jingmen City, Hubei Province 448000, People's Republic of China
| | - Zhang Lei
- Department of Oncology, The Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province 430061, People's Republic of China
| | - Bin Peng
- Oncology Department, Second People's Hospital of Jingmen, Jingmen City, Hubei Province 448000, People's Republic of China
| | - Jiang Zhu
- Oncology Department, Second People's Hospital of Jingmen, Jingmen City, Hubei Province 448000, People's Republic of China
| | - Li Chen
- Department of Traditional Chinese Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Art and Science, Xiangyang City, Hubei Province 441021, People's Republic of China
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Alam M, Hussain S, Shehzad MI, Mushtaq A, Rauf A, Ishaq S. Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft. Cureus 2020; 12:e6851. [PMID: 32181086 PMCID: PMC7053672 DOI: 10.7759/cureus.6851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To compare the effect of incentive spirometry with Acapella (Smiths Medical Inc, Carlsbad, California) in physiotherapy after coronary artery bypass surgery. Methods A randomized controlled trial comparing incentive spirometry with Acapella was conducted in the intensive care unit of Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. The study began from December 2017 to August 2019 after getting approval from the ethical committee of the hospital. Informed written consent was taken from all 270 patients who were included in the study. Patients who underwent coronary artery bypass graft (CABG) were divided into two groups by the lottery method. The primary end-point of the study was to check the blood gases on Day 3 after the procedure at room air and compare it with the baseline and with blood gases immediately after the procedure. SPSS 23 (IBM Corp., Armonk, NY) was used to analyze the data of this study. For qualitative variables in data such as gender, place of living, patients with any comorbidities, and education status were statistically analyzed in percentage and frequencies. For numerical variables, such as age, body mass index, blood gases values, distance covered in a six-minute walk test, and spirometry values were analyzed and statistically measured as mean and standard deviation. A P-value of less than .05 was considered significant. Results The mean partial pressure of oxygen (PaO2) of incentive spirometry was 58.1±2.31 and 67.2±3.24 after extubation and after three days, respectively. While the PaO2 of Acapella was 56.3±3.43 and 66.4±3.54 after extubation and after three days, respectively. The mean PCO2 of incentive spirometry was 41.4±3.26 and 36.1±2.11 after extubation and after three days, respectively. While the partial pressure of carbon dioxide (PCO2) of Acapella was 39.4±2.55 and 37.5±3.58 after extubation and after three days, respectively. The differences were statistically significant at p-value ≤0.05. Conclusion It was concluded that both Acapella and incentive spirometry treatment after coronary artery bypass graft improved blood gases.
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Affiliation(s)
- Masood Alam
- Pulmonology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Shafqat Hussain
- Cardiac Surgery, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | | | - Azam Mushtaq
- Pulmonology, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Abdul Rauf
- Pulmonology, Dera Ghazi Khan Teaching Hospital, Dera Ghazi Khan, PAK
| | - Sohaib Ishaq
- Internal Medicine: Critical Care, Services Hospital, Lahore, PAK
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34
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Crabtree TD, Boffa DJ, Lobdell KW, Habib RH, Gaissert HA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2019 Update on Research. Ann Thorac Surg 2019; 108:1293-1298. [DOI: 10.1016/j.athoracsur.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
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35
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Oprea AD, Perrino AC, Popescu WM. Enhanced Recovery After Lung Surgery: Fad or Fashion? J Cardiothorac Vasc Anesth 2019; 33:2445-2447. [DOI: 10.1053/j.jvca.2019.03.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
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36
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Wang Z, Wang Y. Editorial on: "Acute kidney injury after lung cancer surgery: incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide". J Thorac Dis 2019; 11:S1423-S1425. [PMID: 31245150 DOI: 10.21037/jtd.2019.02.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zihao Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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Ibrahim K, Burt BM. The impact of insight on post-lobectomy complications. J Thorac Dis 2019; 11:S289-S290. [PMID: 30997200 DOI: 10.21037/jtd.2019.01.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kareem Ibrahim
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Bryan M Burt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Delayed recovery following thoracic surgery: persistent issues and potential interventions. Curr Opin Anaesthesiol 2019; 32:3-9. [PMID: 30507683 DOI: 10.1097/aco.0000000000000669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Lung and esophageal surgery remain a curative option for resectable cancers. However, despite advances in surgical and anesthesia practices, the inclusion of patients with comorbidities that would have previously not been offered curative resection presents additional concerns and challenges. RECENT FINDINGS Perioperative complication rates remain high and prolonged and/or painful recovery are common. Further, many patients face a permanent decline in their functional status, which negatively affects their quality of life. Examination of the variables associated with high complications following thoracic surgery reveals patient, physician, and institutional factors in the forefront. Anesthesiologist training, Enhanced Recovery After Surgery protocols, and preparations to minimize "failure to rescue" when a complication does arise are key strategies to address adverse outcomes. SUMMARY Delayed and complicated recovery after thoracic noncardiac surgery persist in current practice. This review analyzes the diverse factors that can impact complications and quality of life after lung surgery and the interventions that can help decrease length of stay and improve return to baseline conditions.
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Abstract
PURPOSE OF REVIEW Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization. RECENT FINDINGS Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications. SUMMARY The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.
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Crabtree TD, Gaissert HA, Jacobs JP, Habib RH, Fernandez FG. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2018 Update on Research. Ann Thorac Surg 2018; 106:1288-1293. [PMID: 30267695 DOI: 10.1016/j.athoracsur.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Traves D Crabtree
- Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St. Petersburg, Tampa, and Orlando, Florida
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
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Stanifer BP, Andrei AC, Liu M, Meyerson SL, Bharat A, Odell DD, DeCamp MM. Short-Term Outcomes of Tracheal Resection in The Society of Thoracic Surgeons Database. Ann Thorac Surg 2018; 106:1612-1618. [PMID: 30240762 DOI: 10.1016/j.athoracsur.2018.07.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tracheal surgery is uncommon, and most of the published literature consists of single-center series over large periods. Our goal was to perform a national, contemporary analysis to identify predictors of major morbidity and mortality based on indication and surgical approach. METHODS The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) was queried for all patients undergoing tracheal resection between 2002 and 2016. We identified 1,617 cases and compared outcomes by indication and approach. We created a multivariable model for a combined end point of mortality or major morbidity. The relationship between volume and outcome was analyzed. RESULTS The cervical approach was used 81% of the time, and benign disease was the indication in 75% of cases. Overall 30-day mortality was 1%, and no significant difference was found between the cervical and thoracic approach (1.1% versus 1.6%, p = 0.57) or between benign and malignant indications (1.1% versus 1.5%, p = 0.61). Independent factors associated with morbidity or mortality included thoracic approach, diabetes, and functional status. Centers were divided into those averaging fewer than four resections per year and those performing at least four per year. The low volume (<4) group had a combined morbidity and mortality of 27%, significantly higher than 17% observed among centers with more than four per year (p < 0.0001). CONCLUSIONS STS GTSD participants perform tracheal resection for benign and malignant disease with low early morbidity and mortality. Higher operative volume is associated with improved outcome. Longer follow-up is needed to confirm airway stability and rate of reoperation.
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Affiliation(s)
- Bryan Payne Stanifer
- Department of Surgery, Section of Thoracic Surgery, Columbia University Medical Center, New York, New York.
| | | | - Menghan Liu
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shari L Meyerson
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Malcolm M DeCamp
- Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Murthy SC. It's not how you finish, it's how you start? J Thorac Cardiovasc Surg 2017; 155:1209-1210. [PMID: 29249484 DOI: 10.1016/j.jtcvs.2017.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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43
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Cheng X, Chen H. Commentary on the impacts of postoperative complications on survival after lung cancer surgery. J Thorac Cardiovasc Surg 2017; 155:1265-1266. [PMID: 29198796 DOI: 10.1016/j.jtcvs.2017.10.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Xinghua Cheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
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