Risk factor analysis for postoperative acute respiratory distress syndrome and early mortality after pneumonectomy: The predictive value of preoperative lung perfusion distribution
Received 14 May 2009; received in revised form 27 September 2009; accepted 8 November 2009. published online 04 February 2010. Corrected Proof
Objectives
This study aims to establish the preoperative risk factors in the development of acute respiratory distress syndrome (ARDS) and early mortality after pneumonectomy for lung cancer and to examine the influence of reduced pulmonary perfusion on outcomes.
Methods
Between 1994 and 2009, of 425 patients who underwent simple pneumonectomy for primary lung cancer, 164 who were preoperatively evaluated with lung perfusion scanning formed the population of this study.
Results
Of 30 (18.3%) patients who had major pulmonary complications, 17 (10.4%) progressed to ARDS, 15 of whom subsequently died. On multivariable logistic regression analyses, lower predicted postoperative forced expiratory volume in 1 second (ppo-FEV1; relative risk of 0.93 [P = .020] for ARDS and 0.94 [P = .027] for mortality) and greater perfusion fraction of resected lung (relative risk of 1.10 [P = .003] for ARDS and 1.09 [P = .002] for mortality) were found to be independent factors associated with ARDS and early mortality. With a cut-off value of 35% for perfusion fraction of resected lung, patients with a perfusion fraction of greater than 35% had a greater incidence of ARDS (17.3% vs 3.3%, P = .005) and early mortality (19.8% vs 6.0%, P = .010) than those with a perfusion fraction of 35% or less.
Conclusions
Patients with a low ppo-FEV1, a high perfusion fraction of resected lung, or both had a higher incidence of ARDS and early mortality after pneumonectomy. Therefore, although the ppo-FEV1 appears to be within an acceptable limit for pneumonectomy, much attention should be given to patients with a high perfusion fraction of resected lung.
aDepartment of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
bDepartment of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
Address for reprints: Seung-Il Park, MD, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong Songpa-gu, Seoul 138-736, Korea.
ABSTRACT