Abstract
BackgroundPostoperative complications after lung surgery are frequent, having a detrimental effect on patients’ further course. Complications may lead to an increased length of hospital stay and cause additional costs. Several risk factors have been identified but it is still difficult to predict contemporary which patients are at risk. We hypothesized that patients who show an increased inflammatory response at the time of wound closure and 24 hours after surgery are at risk of postoperative complications within 30 days after surgery.MethodsPostoperative complications (pulmonary, cardiac, neurological and renal) of 96 patients scheduled for lung surgery at the Medical Center–University of Freiburg were analyzed in this prospective, clinical study. Blood samples for cytokine analysis (Interleukin (IL)-6, IL-8, IL-10, Tumor necrosis factor [TNF]-α, IL-1ß and IL12p70) were taken before surgery, at wound closure and 24 hours after surgery. Cytokine levels of patients with and without postoperative complications were analyzed by Receiver operating characteristic (ROC) curve analysis. To adjust the results according to existing covariates a multivariate logistic regression analysis was conducted.ResultsThe complication and non-complication group differed significantly according to nicotine dependency, Angiotensin-receptor-II blocker medication, rate of thoracotomy and preoperative lung function. The intraoperative hemodynamic parameters and therapy did not differ between the groups. Twenty-nine patients (30%) developed postoperative complications within 30 days after surgery. Plasma concentrations of IL-6, IL-10 and IL-8 at the time of wound closure and 24 hours after surgery were higher in the complication group. Multivariate regression analysis on postoperative complications revealed an Odds ratio of 56 for patients with IL-6 and IL-8 levels above the 3rd quartile measured on the first postoperative day.ConclusionsPerioperative detection of increased plasma concentrations of inflammatory cytokines in lung surgery may be used in addition to other clinical predictors to identify patients at risk for postoperative complications.Trial registrationGerman Clinical Trials Register 00006961.
Highlights
Postoperative complications after lung surgery, of pulmonary origin, are the main reason for a prolonged hospital stay with an incidence of up to 24%.[1]
Plasma concentrations of IL-6, IL-10 and IL-8 at the time of wound closure and 24 hours after surgery were higher in the complication group
Perioperative detection of increased plasma concentrations of inflammatory cytokines in lung surgery may be used in addition to other clinical predictors to identify patients at risk for postoperative complications
Summary
Postoperative complications after lung surgery, of pulmonary origin, are the main reason for a prolonged hospital stay with an incidence of up to 24%.[1]. 3, decreased forced expiratory volume in 1 second (FEV1) preoperatively, smoking, age and thoracotomy whereas predictive biomarkers have not been taken into consideration.[2,4,6] Non-cardiac thoracic surgery leads to a systemic release of pro- and anti-inflammatory cytokines especially on the day of surgery and first postoperative day.[7,8,9] Apart from the trauma caused by surgical incision, patients’ lungs experience ischemia/reperfusion injury due to one-lung ventilation.[10] As a consequence, macrophages in the alveoli secret a variety of cytokines. We hypothesized that inflammatory cytokines measured at the time of wound closure and on the first postoperative day can identify patients at risk of postoperative complications after lung surgery. We hypothesized that patients who show an increased inflammatory response at the time of wound closure and 24 hours after surgery are at risk of postoperative complications within 30 days after surgery
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