Postoperative Acute Lung Injury Following Lobectomy for Non-Small Cell Lung Cancer: What Are the Risk Factors?

Abstract

SESSION TITLE: Lung Cancer SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Acute lung injury following lung resection surgery is not rare and is often related to mortality. Although there is a significant clinical and economic impact associated with increased intensive care unit (ICU) utilization, length of hospital stay, and associated cost, these factors cannot be predicted with any accuracy. The aim of this study was to identify the modifiable risk factors of postoperative acute lung injury (PALI) following lung cancer surgery. METHODS: We retrospectively analyzed the medical records of 354 cases of lung cancer surgery from a tertiary university hospital spanning the period from January 2012 to December 2015. PALI was defined, within one week postoperatively, as bilateral diffuse pulmonary infiltration on chest radiography, oxygenation failure (PaO2/FiO2 < 300), and the absence of signs of left ventricular failure. We classified patients into one of two groups, PALI or non-PALI, and compared the clinical characteristics between the two groups. A logistic regression model was fitted to evaluate the risk factors of PALI. RESULTS: Among 354 cases of lung cancer surgery, 287 lobectomies were analyzed. The overall incidence of PALI was 2.79% (8/287); four patients developed pneumonia with acute respiratory distress syndrome, and four patients developed ALI with no clinical signs of infection. There was no difference in baseline characteristics between the PALI and non-PALI groups; however, regarding surgical parameters, a higher volume of fluid infusion was observed in the PALI group. The logistic regression model revealed underlying ischemic heart disease (odds ratio (OR) 7.67, 95% confidence interval (CI) 1.21-47.44, p=0.03), interstitial lung disease (OR 30.36, 95% CI 2.30-401.52, p=0.01), intraoperative intravascular crystalloid fluid (OR 1.10, 95% CI 1.00-1.20, p=0.04), and intraoperative transfusion (OR 56.4, 95% CI 3.53-901.39, p<0.01) as risk factors of PALI. PALI increased the frequency of ICU admission, the use of mechanical ventilation, the duration of hospital stay, and mortality. CONCLUSIONS: The clinical impacts of PALI are considerable. The significant independent risk factors identified were underlying ischemic heart disease, interstitial lung disease, intravascular crystalloid fluid, and intraoperative transfusion. CLINICAL IMPLICATIONS: Close observation is necessary for patients with ischemic heart disease or interstitial lung disease, following lung cancer surgery, to identify the development of acute lung injury can be avoided and optimize the intraoperative fluid and transfusion. DISCLOSURE: The following authors have nothing to disclose: Hyun Jung Kim, Chan-Hee Lee No Product/Research Disclosure Information