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Clinical Investigations: SURGERY |

Risk Factors for Early Mortality and Major Complications Following Pneumonectomy for Non-small Cell Carcinoma of the Lung*

Marc Licker, MD; Anastase Spiliopoulos, MD; Jean-Georges Frey, MD; John Robert, MD; Laurent Höhn, MD; Marc de Perrot, MD; Jean-Marie Tschopp, MD, FCCP
Author and Funding Information

*From the Department of Anesthesiology, Pharmacology, and Surgical Intensive Care (Drs. Licker and Höhn), the Unit of Thoracic Surgery (Drs. Spiliopoulos, Robert, and de Perrot), the University Hospital of Geneva, Geneva, Switzerland; and the Chest Medical Center (Drs. Frey and Tschopp), Valais, Switzerland.

Correspondence to: Marc Licker, MD, Division d’Anesthésiologie, Hopital Universitaire, rue Micheli-Ducrest, CH-1211 Genève 14; e-mail: marc-joseph.licker@hcuge.ch



Chest. 2002;121(6):1890-1897. doi:10.1378/chest.121.6.1890
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Study objectives: To assess the mortality rate and the incidence of cardiopulmonary complications after pneumonectomy for non-small cell lung carcinoma (NSCLC) and to identify possible associated risk factors.

Design: Observational study of patients who underwent pneumonectomy. Potential risk factors were analyzed from a local database including all thoracic surgical cases.

Setting: A university hospital and a chest medical center.

Patients and methods: From January 1, 1990, to April 30, 2000, 193 consecutive pneumonectomies were performed for NSCLC in two affiliated institutions. The following information was recorded: demographic, clinical, functional, and surgical variables; as well as intraoperative and postoperative events. The risk of mortality and cardiopulmonary complications was evaluated using multiple logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: After undergoing pneumonectomy, all patients were successfully extubated in the operating room and then transferred to a postanesthesia care unit (126 patients) or ICU (67 patients). The 30-day mortality rate was 9.3%, and cardiovascular and/or pulmonary complications occurred in 47% of cases. Coronary artery disease (CAD) was a predictor of 30-day mortality (OR, 2.9; 95% CI, 1.1 to 8.9). Cardiac morbidity (mainly arrhythmias) was significantly related to advanced age (OR, 3.7; 95% CI, 1.6 to 8.6) and pathologic stages III/IV (OR, 1.4; 95% CI, 1.1 to 4.7), whereas continuous epidural analgesia was associated with a reduced incidence of respiratory complications (OR, 0.2; 95% CI, 0.1 to 0.6).

Conclusions: Pneumonectomy for lung cancer is a high-risk procedure, the risk for which is significantly related to the presence of CAD and advanced pathologic stages. Importantly, the provision of epidural analgesia contributes to lower the risk of respiratory complications.


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