Study objectives: To assess the incidence and clinical
implications of postoperative pulmonary complications (PPCs) after lung
resection, and to identify possible associated risk factors.
Design: Retrospective study.
885-bed teaching hospital.
Patients and methods: We
reviewed all patients undergoing lung resection during a 3-year period.
The following information was recorded: preoperative assessment
(including pulmonary function tests), clinical parameters, and
intraoperative and postoperative events. Pulmonary complications were
noted according to a precise definition. The risk of PPCs associated
with selected factors was evaluated using multiple logistic regression
analysis to estimate odds ratios (ORs) and 95% confidence intervals
Results: Two hundred sixty-six patients were
studied (87 after pneumonectomy, 142 after lobectomy, and 37 after
wedge resection). Sixty-eight patients (25%) experienced PPCs, and 20
patients (7.5%) died during the 30 days following the surgical
procedure. An American Society of Anesthesiology (ASA) score ≥ 3 (OR,
2.11; 95% CI, 1.07 to 4.16; p < 0.02), an operating time > 80 min
(OR, 2.08; 95% CI, 1.09 to 3.97; p < 0.02), and the need for
postoperative mechanical ventilation > 48 min (OR, 1.96; 95% CI,
1.02 to 3.75; p < 0.04) were independent factors associated with the
development of PPCs, which was, in turn, associated with an increased
mortality rate and the length of ICU or surgical ward stay.
Conclusions: Our results confirm the relevance of the ASA
score in a selected population and stress the importance of the length
of the surgical procedure and the need for postoperative mechanical
ventilation in the development of PPCs. In addition, preoperative
pulmonary function tests do not appear to contribute to the
identification of high-risk patients.