Automated quantification of interstitial lung abnormalities and emphysema on computed tomography: a predictive marker for postoperative pulmonary complications after esophagectomy.

Neurological complications pose significant risks in coronary artery bypass grafting (CABG). This study explores the potential benefits of preoperative chest computed tomography (CT) in optimizing outcomes and reducing neurological events in high-risk CABG patients. From January 2017 to June 2023, a retrospective cohort study of CABG patients categorized groups based on preoperative chest CT use. Multivariate analysis evaluated the associations between CT imaging and patient characteristics, followed by propensity match analysis to balance preoperative features across groups. The study included 1786 patients, with 435 having undergone preoperative CT and 1351 without. Propensity matching created two well-balanced groups of 413 patients each. At multivariate analysis, CT patients were elderly (71.1 ± 8.9 years; p = 0.03) with a higher incidence of pulmonary disease (19.5%; p < 0.01), peripheral arterial disease (29.2%; p < 0.01), and previous cerebrovascular disease (23.4%; p = 0.02). In the matched CT cohort, the perioperative cerebral stroke rate was 0.7% (vs. 1.9% in without preoperative CT [WCT] cohort; p = 0.223), and the 30-day mortality rate was 0.2% (vs. 1.7% in WCT cohort; p = 0.069). Patients who had a preoperative CT study presented a higher prevalence of porcelain aorta (6.3% vs. 1.5%; p = 0.0003) and required more often a no-touch aorta procedure (20.3% vs. 14.5%; p = 0.035). Patients undergoing preoperative chest CT before CABG were typically older and had systemic atherosclerosis and pulmonary disease. Propensity-matched analysis indicated low mortality and perioperative cerebral stroke rates in these high-risk patients. These findings support the integration of chest CT into preoperative evaluations for high-risk patients to develop tailored strategies in coronary artery bypass surgery.

Background: Post operative pulmonary complications (PPC) contribute to increased morbidity and mortality. Thus pre operative assessment is required. Six minute walk test (6-MWT) is a simple and reliable test which is recently being included in pre operative evaluation.&#x0D; Objectives: The objective of this study is to determine the value of the six minute walk test as a reliable tool in detecting post operative pulmonary complications in patients undergoing abdominal surgery.&#x0D; Materials and Methods: It is a prospective observational study conducted in a tertiary care centre for a period of 3 months. 66 patients in the age group of 40-60 years undergoing elective abdominal surgery under general anaesthesia were included in this study based on universal sampling method. Patients with recent coronary syndrome, uncontrolled hypertension, cardiac diseases, pregnancy and conditions which impair walking (eg. Arthiritis) were excluded from the study. 6 minute walk test was performed before the surgery. The procedure was explained to the patients and consent was obtained. The test was conducted on a flat surface of 20m near our pre anaesthetic clinic and the patient was asked to walk for a period of 6 minutes in their own comfortable pace. The distance covered by the patients in the 6 minutes was noted. Vitals such a SpO2, heart rate, systolic and diastolic blood pressures were recorded before and after the test. The patients were followed up for the development of pulmonary complications in the post operative period.&#x0D; Results: Out of the 66 patients included in the study, 35 patients did not develop PPC (Group 1) and 31 patients developed PPC (Group2) including one death due to respiratory failure. The six minute walk distance in the PPC group was significantly less (p=0.0001) when compared to that of the non PPC group. Patients in the PPC group also required prolonged hospital stay. Pneumonia was the most commonly developed post operative pulmonary complication.&#x0D; Conclusion: Six minute walk test is a useful tool in predicting post operative pulmonary complication in patients undergoing abdominal surgery.

Preoperative Serum Fibrinogen Level Predicts Postoperative Pulmonary Complications After Lung Cancer Resection

Introduction: It is believed that pressure/flow (P/F) ratio (arterial oxygen to inspired oxygen fraction) does not give the best expression of oxygenation status in mechanically ventilated patients. Therefore, a new oxygenation index (OI) where the mean airway pressure (MAP) is incorporated (PaO2/FiOxMAP) is showed as superior to P/F in expression of the lung oxygenation status. In this article we wanted to assess the prediction value of OI calculated during urological surgeries as a predictive marker for developing postoperative pulmonary complications (PPC).&#x0D; Material and methods: We evaluated all elective urologic patients operated in general endotracheal anesthesia, aged 18 to 65 years, without any known history of respiratory disease for the period from January till December 2017. We calculated the P/F ratio and the OI at three time points: after induction in general endotracheal anesthesia in the beginning of mechanical ventilation, 1 hour after induction in anesthesia, and at the end of the surgery before weaning the mechanical ventilation. The primary outcomes were PPC defined by European Society of Anesthesia. The second outcomes were: length of hospital stay, admission to intensive care unit (ICU) and mortality. &#x0D; Results: A total of 240 patients who met the inclusion criteria were included in this evaluation and finally analyzed. PPC were diagnosed in 25% of patients and respectively 75% were without complications. Postoperative hospital stay was longer in PPC group no matter they were operated laparoscopically or with classic open surgery (PPC laparoscopy 4.9 ± 2.2 vs. non PPC laparoscopy 3.3 ± 1.7, PPC laparotomy 6.8 ± 5.2 vs. non PPC 5.6 ± 2.1 laparotomy). Ten patients were admitted to ICU, 8 from PPC group and 2 from non PPC group. In PPC group patients were admitted to ICU for mean 3.7 ± 2.4 days, and in non PPC group patients were hospitalized in ICU only for 2 days. All evaluated patients were discharged from the hospital and no mortality was observed in the 30 postoperative days.&#x0D; In the univariate and multivariate logistic regression analysis neither OI nor P/F were significantly associated with PPC.&#x0D; Conclusion: This study does not offer a conclusive answer to the prediction value of OI for PPC. It would be fruitful to pursue further research about predictive variables for pulmonary complications.

Little is known about the benefits of preoperative staging chest computed tomography (CT) in patients with asymptomatic breast cancer. We therefore investigated the clinical value of preoperative chest CT in detecting lung and liver metastases by retrospectively reviewing the records of 1,703 patients who underwent preoperative chest CT in a single institution between January 2006 and June 2009. Abnormal CT findings, including suspected metastases and indeterminate nodules in the lung or liver, were found in 266 patients (15.6%). Among these, 26 patients (1.5% of all patients and 9.8% of patients with abnormal CT findings) had true metastases, including 17 in the lungs, 3 in the liver, and 6 in both. True metastases were detected in 1 (0.2%), 0 (0%), and 24 (6.0%) patients with stage I, II, and III disease, respectively. The sensitivity, specificity, and positive predictive value of chest CT were 100, 89.1, and 11.3%, respectively, for lung metastasis and 100, 97.6, and 18.4%, respectively, for liver metastasis. All true metastatic lung lesions were all small-sized nodules, ranging from 0.2 to 1.5 cm in largest diameter, and could not be detected on chest X-rays. In conclusion, our results demonstrate the lack of usefulness of routine preoperative chest CT in detecting asymptomatic liver and lung metastasis in patients with early breast cancer. Chest CT, however, upstaged 6.0% of stage III patients to stage IV.

Background and objectiveThe prevalence of lung cancer has been increasing in healthy elderly patients with preserved pulmonary function and without underlying lung diseases. We aimed to determine the prevalence of and risk factors for postoperative pulmonary complications (PPCs) in healthy elderly patients with non-small cell lung cancer (NSCLC) to select optimal candidates for surgical resection in this subpopulation.MethodsWe included 488 patients older than 70 years with normal spirometry results who underwent curative resection for NSCLC (stage IA-IIB) between 2012 and 2016.ResultsThe median (interquartile range) age of our cohort was 73 (71–76) years. Fifty-two patients (10.7%) had PPCs. Severe PPCs like acute respiratory distress syndrome, pneumonia, and respiratory failure had prevalences of 3.7, 3.7, and 1.4%, respectively. Compared to patients without PPCs, those with PPCs were more likely to be male and current smokers; have a lower body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification, more interstitial lung abnormalities (ILAs), and higher emphysema index on computed tomography (CT); and have undergone pneumonectomy or bilobectomy (all p < 0.05). On multivariate analysis, ASA classification ≥3, lower BMI, ILA, and extent of resection were independently associated with PPC risk. The short-term all-cause mortality was significantly higher in patients with PPCs.ConclusionsCurative resection for NSCLC in healthy elderly patients appeared feasible with 10% PPCs. ASA classification ≥3, lower BMI, presence of ILA on CT, and larger extent of resection are predictors of PPC development, which guide treatment decision-making in these patients.

Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs. 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs. 90.6 ± 20.9%; P > 0.05). The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.

The diagnostic value of routine chest computed tomography (CT) in addition to abdominal CT in workup for pancreatic head carcinoma is unclear. The aim of this study was to determine if routine chest CT revealed significant lesions that altered the management of patients with suspected pancreatic head carcinoma. All Dutch pancreatic cancer centers were surveyed on the use of chest CT in preoperative staging. In addition, a single-center retrospective cohort study was performed including all patients referred with suspected pancreatic head malignancy without chest CT between 2005 and 2016. The primary end point was the proportion of patients in which chest CT revealed clinically significant lesions, leading to a change in management. In 7 of 18 Dutch pancreatic cancer centers (39%), a preoperative chest CT is not routinely performed. In the study cohort, 170 of 848 patients (20%) were referred without chest CT and underwent one by local protocol. Chest CT revealed new suspicious lesions in 17 patients (10%), of whom 6 had metastatic disease (3.5%). Routine use of chest CT in diagnostic workup for pancreatic head carcinoma reveals clinically significant lesions in 10% of patients, being metastases in up to 4%.

Background: Active surveillance is accepted as a first-line management for patients with low-risk papillary thyroid microcarcinoma (PTMC) without metastasis or extrathyroid extension. While the lung is the most frequent site of distant metastasis of papillary thyroid carcinomas (PTCs), it is unclear if chest computed tomography (CT) is necessary at the initiation of active surveillance. In our institution, we usually did not perform chest CT for candidates identified for active surveillance. However, routine preoperative chest CT for patients with thyroid cancers, including PTMCs, was standard practice. The present study aimed to evaluate the clinical value of chest CT for patients with PTMCs.Methods: We retrospectively reviewed preoperative chest CT images from 1000 consecutive patients (88.5% women; median age, 55 years) with cT1aN0 PTC who underwent surgery between January 2006 and May 2012 in our hospital. The median maximum size of PTMCs was 8 mm.Results: Abnormal findings were detected in 326 (32.6%) of the 1000 patients. Of these, 290 patients had presumed benign or inflammatory lesions of no clinical importance. In total, 36 patients (3.6%) were referred to specialized departments for further evaluation of the lesions, and 9 patients (0.9%) received invasive tests and/or treatments. Five patients (0.5%) benefited from the chest CT (lung cancer was detected in four, and a cardiac lesion was detected and treated in one), while the lesions in the other four patients were benign, not necessarily requiring treatment. The remaining 27 patents were followed for presumed benign or inflammatory lesions. Thus, none of the present 1000 patients was found with distant metastasis of thyroid cancer.Conclusions: Routine chest CT did not detect thyroid cancer lung metastasis in patients with PTMC. Thus, routine chest CT at the time of presentation is not required for patients with cT1aN0 PTCs.

Superiority of respiratory failure risk index in prediction of postoperative pulmonary complications after digestive surgery in Japanese patients.

Postoperative pulmonary complications (PPCs) significantly impact the prognosis of elderly patients undergoing coronary artery bypass grafting (CABG), yet the risk factors for PPCs in CABG remain uncertain. The objective of this study is to identify risk factors for PPCs in elderly patients undergoing CABG. This study retrospectively analyzed 305 elderly patients who underwent CABG at Xuanwu Hospital, from January 2019 to December 2023. The variables analyzed included patient demographics, comorbidities, anesthesia factors, surgical factors and perioperative laboratory tests. Based on the occurrence of PPCs, patients were divided into the PPC group and the none-PPC group. Univariate analysis and multivariate logistic regression analysis were employed to determine the independent risk factors of PPCs in elderly patients undergoing CABG. Of the 305 patients, 148 developed PPCs, resulting in an incidence rate of 48.5%. Compared to the none-PPCs group, patients in the PPCs group had significantly longer postoperative lengths of stay and higher perioperative mortality rates. The results indicated that NYHA classification ≥ III (P = 0.024, OR: 1.791, 95%CI: 1.080 ~ 2.972), preoperative P/F ratio (PaO2/FiO2) < 350 mmHg (P = 0.002, OR: 2.363, 95%CI: 1.371 ~ 4.073) and postoperative albumin level (P = 0.020, OR: 0.946, 95%CI: 0.903 ~ 0.991) were independent risk factors for PPCs in elderly patients undergoing CABG. This study identified NYHA classification ≥ III, preoperative P/F ratio < 350 mmHg and postoperative albumin levels as independent predictors of PPCs in elderly patients undergoing CABG. Further study is needed to validate these findings and explore potential interventions to mitigate the risk of PPCs in elderly CABG patients.

To evaluate the impact of postoperative pulmonary complications (PPCs) on short-term health-related quality of life (HRQOL) in older adults (60-80years) with early-stage nonsmall cell lung cancer (NSCLC) after video-assisted thoracic surgery (VATS). A total of 261 patients with stage I NSCLC were enrolled. PPCs (defined according to European Perioperative Clinical Outcome criteria and graded using the Kroenke score) occurred in 72 (27.6%). The MD Anderson Symptom Inventory for Lung Cancer (MDASI-LC) longitudinally assessed symptoms and recovery trajectories at preoperative baseline, discharge, and post-discharge (days 7, 30, 60, and 90). Multivariable Cox regression identified delayed-recovery predictors. Patients with PPCs had prolonged median hospitalization (median 6days, interquartile range [IQR]: 4-9 vs. 4days, IQR: 3-5; p<0.001). At discharge, the PPCs group showed significantly higher MDASI-LC scores across seven items (adjusted mean differences: +0.46 to +0.67; all p<0.05, Bonferroni-adjusted) except coughing. During the 90-day follow-up, the PPCs group exhibited persistently elevated coughing (day 30: +0.56) and shortness of breath (day 7: +0.52; day 60: +0.66; all p<0.05). Kaplan-Meier analysis confirmed delayed recovery with PPCs for shortness of breath (median 88 vs. 58days), coughing (95 vs. 70days), and activity interference (94 vs. 86days) (all p<0.05). Multivariable Cox regression demonstrated PPCs independently delayed recovery (adjusted hazard ratios [aHRs]: 0.442-0.535), while lobectomy (vs. sublobectomy) increased risk (aHRs: 0.535-0.659). Subgroup analysis stratified by surgical extent and PPCs status revealed synergistic effects: VATS lobectomy with PPCs showed slowest recovery (shortness of breath: median 88days, coughing: 95days and activity interference: 94days), while sublobectomy without PPCs had fastest recovery (shortness of breath: 54days, coughing: 58days and activity interference: 71days; all p<0.05, Bonferroni-adjusted). PPCs significantly extend hospitalization and delay recovery of respiratory symptoms (shortness of breath, coughing) and activity interference in older NSCLC patients after VATS. The synergistic effect of lobectomy and PPCs exacerbates delays. Prioritizing sublobectomy when oncologically feasible, and implementing aggressive PPC prevention for lobectomy candidates, optimizes postoperative HRQOL.

Purpose: The lung represents the second most metastatic site after the liver in colorectal cancer (CRC). Traditionally, pulmonary metastasis has been evaluated by means of a chest X-ray. But, recently, chest computed tomography (CT) is increasingly being performed to detect pulmonary metastasis in CRC. This study was performed to evaluate the usefulness of chest CT over chest X-ray for early detection of pulmonary metastasis in preoperative staging in CRC. Methods: We retrospectively reviewed 108 cases of CRC patients surgically treated with a curative intent at Chonbuk National University Hospital from April, 2007 to December, 2007. All evaluated by both chest X-ray and chest CT preoperatively. Results: Five among 108 patients had metastatic lesions of the lung. Four of these 5 patients (80%) had a positive chest CT. But one of these 5 patients (20%) had a positive chest X-ray. Chest CT provided a sensitivity of 80% and a positive predictive value of 80% for the detection of metastatic lesions of the lung. In contrast, chest X-ray provided a sensitivity of 20% and a positive predictive value of 50% for the detection of metastatic lesion of the lung. Nine of these 108 patients (8%) were diagnosed with solitary pulmonary nodule (SPN) and one of them was confirmed to have metastatic lesion of the lung. Conclusion: There are isolated metastatic lung lesions without other organ involvement in CRC (4.6%). Chest CT is a more accurate imaging modality for detection of pulmonary metastasis in CRC. Also, we should carefully follow-up SPN detected by preoperative chest CT.

Introduction: Post-operative pulmonary complications (PPC) are a major cause of death after lung resection and responsible for delayed discharge and intensive care admissions (Agostini, et al 2008. Thorax , 63 , A10-A12). 2008). Early detection is fundamental to treatment. Aims: We hypothesised breathing motion measured by Structured Light Plethysmography (SLP) can detect early signs of PPC. Methods: 5 minutes of tidal breathing was measured, pre-surgery (PRE) and day 1 (D1) and day 2 (D2) post-surgery with SLP (Thora-3Di, PneumaCare Ltd) in 11 seated patients. 3 patients developed PPC (the PPC group, PPCG). 8 patients did not develop PPC (the control group, CG). % change in SLP parameters PRE to D1 were compared between PPCG and CG using a Student t-test. Results: PPC was diagnosed in all PPCG patients on D2. PPC scores were not diagnostic of PPC on D1. On D1 the % change in synchronization between rib cage and abdomen was higher in PPCG than CG. The % change of time to reach maximum inspiratory flow was also higher in PPCG Conclusion: SLP may provide clinically-useful respiratory indices to detect early signs of PPC before a PPC scoring system diagnosis can be made.

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.