Incidence of and risk factors for cardiovascular complications after thoracic surgery for noncancerous lesions.

OBJECTIVE The purpose of this study was to determine the incidence of and risk factors for cardiovascular complications after thoracic surgery for noncancerous lesions. DESIGN Retrospective cohort study. SETTING A tertiary medical center. PARTICIPANTS All consecutive patients undergoing either thoracotomy or thoracoscopy for noncancerous lesions between 2005 and 2011 were included. MEASUREMENTS AND MAIN RESULTS The primary outcomes were the incidence and types of cardiovascular complications such as cardiac arrhythmias, cardiac arrest, heart failure, and myocardial ischemia during hospitalization. A total of 719 patients were recruited, 60% of whom had infections. The incidence of cardiovascular complications after thoracic surgery was 6.7% (48 of 719), of which cardiac arrhythmia was the most common (25 of 48, 52%). The multivariate risk regression analysis showed that age>55 years (risk ratio [RR]=4.0; 95% confidence interval [CI]=2.1-7.5; p<0.01), diabetes mellitus (RR=3.0; 95% CI=1.7-5.3; p<0.01), coronary artery disease (RR=4.8; 95% CI=2.3-10.2; p<0.01), duration of surgery>180 minutes (RR=2.6; 95% CI=1.3-5.1; p<0.01), intraoperative hypotension (RR=2.6; 95% CI=1.6-4.3; p<0.01), and positive fluid balance>2,000 mL (RR=2.5; 95% CI=1.4-4.5; p<0.01) were independent risk factors for cardiovascular complications. CONCLUSIONS Knowledge of risk factors could help surgical teams to identify high risk patients and adjust modifiable risk factors including optimization of medical conditions, correction of intraoperative hypotension, and appropriate blood and fluid administration in order to reduce perioperative morbidity and mortality.

[1]  A. Garg,et al.  Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery: Toward an Empirical Definition of Hypotension , 2013, Anesthesiology.

[2]  Hao Wang,et al.  Risk factors for early postoperative complications after pneumonectomy for benign lung disease. , 2013, The Annals of thoracic surgery.

[3]  S. Force,et al.  Pneumonectomy for benign disease: analysis of the early and late outcomes. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  S. Suksompong,et al.  Thoracic surgery mortality and morbidity in a university hospital , 2012, Asian cardiovascular & thoracic annals.

[5]  Y. Jeon,et al.  Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy: randomised controlled study , 2011, European journal of anaesthesiology.

[6]  Juan Wisnivesky,et al.  Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons General Thoracic Surgery Database. , 2010, The Annals of thoracic surgery.

[7]  M. Berry,et al.  Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. , 2010, The Annals of thoracic surgery.

[8]  M. Berry,et al.  Risk factors for morbidity after lobectomy for lung cancer in elderly patients. , 2009, The Annals of thoracic surgery.

[9]  S. Harada.  [ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery]. , 2009, Masui. The Japanese journal of anesthesiology.

[10]  B. Sweitzer,et al.  ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery , 2008 .

[11]  Karel G M Moons,et al.  Incidence of Intraoperative Hypotension as a Function of the Chosen Definition: Literature Definitions Applied to a Retrospective Cohort Using Automated Data Collection , 2007, Anesthesiology.

[12]  P. Heerdt,et al.  Pulmonary resection in the elderly , 2007, Current opinion in anaesthesiology.

[13]  E. Blackstone,et al.  Atrial fibrillation complicating lung cancer resection. , 2005, The Journal of thoracic and cardiovascular surgery.

[14]  John D. Mitchell,et al.  Completion pneumonectomy for chronic mycobacterial disease. , 2005, The Journal of thoracic and cardiovascular surgery.

[15]  Charles E. McCulloch,et al.  Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models , 2005 .

[16]  W. Boden,et al.  Impact of fluid balance on incidence of atrial fibrillation after cardiothoracic surgery. , 2004, The American journal of cardiology.

[17]  P. Wurnig,et al.  Risk factors for the development of postoperative complications after bronchial sleeve resection for malignancy: a univariate and multivariate analysis. , 2003, The Annals of thoracic surgery.

[18]  H. Kehlet,et al.  Pathophysiology and clinical implications of perioperative fluid excess. , 2002, British journal of anaesthesia.

[19]  A. Bernard,et al.  Completion pneumonectomy: factors affecting operative mortality and cardiopulmonary morbidity. , 2002, The Annals of thoracic surgery.

[20]  J. Tschopp,et al.  Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. , 2002, Chest.

[21]  K. Brasel,et al.  Postoperative atrial fibrillation in noncardiothoracic surgical patients. , 2001, American journal of surgery.

[22]  T. Oaks,et al.  Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias. , 2000, Journal of cardiothoracic and vascular anesthesia.

[23]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.

[24]  W G Henderson,et al.  Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. , 1999, The Journal of thoracic and cardiovascular surgery.

[25]  M Licker,et al.  Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small cell carcinoma. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[26]  J. V. D. van den Bosch,et al.  Completion pneumonectomy: analysis of operative mortality and survival. , 1998, The Annals of thoracic surgery.

[27]  A. Boer,et al.  Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors. , 1997, Chest.

[28]  J L Duque,et al.  Early complications in surgical treatment of lung cancer: a prospective, multicenter study. Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica. , 1997, The Annals of thoracic surgery.

[29]  Y. Ichinose,et al.  The current status of postoperative complications and risk factors after a pulmonary resection for primary lung cancer. A multivariate analysis. , 1997, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[30]  R. Kessler,et al.  Pneumonectomy for chronic infection is a high-risk procedure. , 1996, The Annals of thoracic surgery.

[31]  S. Fountain,et al.  Elective pneumonectomy: factors associated with morbidity and operative mortality. , 1992, The Annals of thoracic surgery.

[32]  L. Lindgren,et al.  Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer. , 1992, The Annals of thoracic surgery.

[33]  Stanley Lemeshow,et al.  Sample Size Determination in Health Studies: A Practical Manual , 1991 .

[34]  W. Browner,et al.  Association of Perioperative Myocardial Ischemia with Cardiac Morbidity and Mortality in Men Undergoing Noncardiac Surgery , 1990 .

[35]  J. Gold,et al.  The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. , 1989, Annals of surgery.

[36]  F. Bonnet,et al.  Institutional report - Thoracic oncologic Risk and protective factors for major complications after pneumonectomy for lung cancer , 2010 .

[37]  P. Dartevelle,et al.  Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[38]  A. Møller,et al.  Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance. , 2002, European journal of anaesthesiology.