Postoperative Cardiopulmonary Complications Research Articles

Integrating cardiopulmonary exercise testing and 6-min walk test for predicting postoperative cardiopulmonary complications in patients undergoing lung cancer surgery: A narrative review

Cardiopulmonary exercise testing (CPET) is an effective method for the assessment of cardiopulmonary and neuromuscular reaction to physical stress. It offers an independent assessment of cardiopulmonary fitness and functional capacity in patients undergoing lung cancer surgery. The 6-min walk test (6MWT) can be used for the assessment of functional capacity when CPET is unavailable. Through this review, we aim to emphasize the importance of utilizing both CPET and 6MWT in the assessment of cardiorespiratory fitness/functional capacity in patients with lung cancer undergoing major thoracic oncological resections. We searched the PubMed electronic database using the MeSH system for articles reporting the use of CPET and 6MWT in cardiopulmonary fitness/functional capacity evaluation during cancer treatment. The full-text articles were assessed, and significant evidence was extracted. Only the articles written in the English language were selected. Using a combination of CPET and 6MWT for the assessment of cardiopulmonary fitness/functional capacity in patients with lung cancer undergoing complex oncological resections, could give a definite prediction of the possibility of postoperative cardiopulmonary complications in these patients.

Applying Cardiac Rehabilitation Exercise Protocol to Reduce Post-operative Cardio-Pulmonary Complications among Open Heart Surgery Patient's

Background: Cardiac surgery is a complex procedure that is resulting in a higher incidence of com­plications and tends to significantly decrease the potential for recovery. It is essential for the nurse to anticipate the treatment of complications so that appropriate interventions are initiated in order to ensure a positive outcome for patients. Aim of the Study:To evaluate the effect of applying cardiac rehabilitation exercise protocol for open heart surgery patient's to reduce post-operative cardio-pulmonary complications. Research Design: Quasi-experimental research design was utilized in the current study. Subjects: A purposive sample including 60 patients male and female, classified equally into two equal groups; study group (n= 30) and control group (n= 30). Setting: This study carried out in the inpatient cardiac surgery department of Cardio-thoracic Surgery Hospital at New Minia City. Tools of Data Collection: Three tools were utilized in collecting data. Tool I: Patient Assessment Sheet, Tool II: Cardiac Rehabilitation Exercise Checklist. Tool Ш: Cardiopulmonary Complications Assessment Sheet. Results: Current study findings revealed that the study group had a lower incidence of cardiac and respiratory complications (30%, and 3.3%) respectively compared to (46.7% and 26.7%) for the control group and there is a statistical significance differences were detected between the two groups. Conclusion: The current study findings concluded that the cardiac rehabilitation exercise protocol in the form of deep breathing, incentive spirometer, coughing and early ambulation induces significant improvement in reducing the risk of post-operative cardio pulmonary complications. Recommendations: Hospitals should recommend implementing cardiac rehabilitation exercise protocols as a routine hospital policy among all cardiac surgical patients in all age groups

Preoperative cardiac and respiratory investigations do not predict cardio-respiratory complications after pancreatectomy.

The process of undergoing a pancreatic resection places a patient under notable physiologic strain throughout the perioperative journey, with well recognized risks of postoperative cardiopulmonary complications. Preoperative preparations and screening often incorporate a barrage of testing, including electrocardiograms, transthoracic echocardiography, chest X-rays and spirometric evaluations. However, the current literature does not demonstrate whether these common tests provide any predictive correlation with postoperative cardiopulmonary complications. This retrospective study is structured to identify complications in post-pancreatic resection patients and assess for a predictive correlation with preoperative test results. A retrospective analysis of all patients having undergone a pancreatic resection at a single tertiary centre, between 2014 and 2016. The inpatient medical records were reviewed for 30-day postoperative complications, including acute myocardial infarction, cardiac dysrhythmia, pulmonary embolism, pneumonia or pleural effusions. The results of routine preoperative diagnostic tests and complication rates were analysed. A total of 244 patients, median age of 66 years (range 18-88 years) were included in the study. Of these, 11 patients experienced a cardiac complication and 16 patients experienced a respiratory complication. Among those who experienced cardiac events, only two patients had abnormalities in their preoperative electrocardiograms. Patients who sustained a cardiac or respiratory event did not have any evidence of abnormality in their preoperative transthoracic echocardiography or respiratory investigations, respectively. Despite the recommendation that high-risk procedures such as pancreatic resections warrant thorough, routine, preoperative cardiac and respiratory investigation, a more functional preoperative assessment should be considered to stratify and predict postoperative outcomes.

The Relationship between Pulmonary Function Testing Including Cardiopulmonary Exercise Testing (CPET) and Outcomes in Patients with Oesophagogastric Cancer Undergoing Neo-adjuvant Chemotherapy

Background: In the field of gastro-oesophageal cancer, the effect of chemotherapy treatment on patients’ cardiopulmonary fitness as well as on the incidence of post-operative cardiopulmonary complications remains controversial. Objectives: To examine the effect of chemotherapy on cardiopulmonary fitness. Further, to examine the association between cardiopulmonary exercise testing and other measurements on outcomes in patients with gastro-oesophageal cancer undergoing neo-adjuvant chemotherapy. And to compare post chemotherapy cardiopulmonary exercise testing with surgical outcome. Patients and methods: Forty-one patients with gastroesophageal cancer who underwent chemotherapy were referred to the Pulmonary Function Laboratory, Respiratory Medicine, Glasgow Royal Infirmary during the period August 2008 to December 2011. 35 of these patients underwent both pre- and post-chemotherapy pulmonary function testing and 31 of these 35 patients had their chemotherapy followed by surgery. A further 6 patients underwent chemotherapy followed by pulmonary function testing and surgery but without pre-chemotherapy testing Results: There were significant differences between the pre- and post-chemotherapy results in arterial PCO2 (p<0.01), t hemoglobin (p<0.001) and heart rate at anaerobic threshold as a % of maximum predicted heart rate (p<0.05). There were significant differences between those patients without post-operative complications and those with post-operative complications, in length of high dependency care stay (p<0.01), length of ward stay (p<0.05) and length of hospital stay (p<0.001) Conclusion: the results of the present study show that there was no significant change in cardiopulmonary fitness in patients with gastro-oesophageal cancer who underwent chemotherapy apart from correctable side effect such as anaemia. In addition, CPET parameters, pulmonary function tests and other related factors did not predict an increase in the risk of post-operative complications. There was, however, a relationship between deprivation and an increased risk of postoperative complications.

Total Endovascular Repair of Contained Ruptured Thoracoabdominal Aortic Aneurysms

To report perioperative and 1-year results of total endovascular repair of contained ruptured thoracoabdominal aortic aneurysms (TAAAs). Between 2015 and 2017, preoperative, procedural, and postoperative data of patients with radiographic evidence of contained ruptured TAAAs treated by endovascular repair were prospectively collected. Only patients with stable hemodynamic parameters were enclosed. Primary endpoints were 30-day/in-hospital mortality, spinal cord ischemia (SCI), postoperative cardiopulmonary complications, and new onset of hemodialysis. Secondary endpoints were endoleaks, reinterventions, and overall follow-up survival. Twelve patients underwent endovascular repair for contained ruptured TAAAs. According with the Crawford/Safi's classification, 6 type II (50%), 3 type III (25%), 1 type IV (8%), and 2 type V (17%) TAAAs were treated. All patients were symptomatic. Overall, 34 target visceral vessels were planned to be revascularized. The mean time from admission to treatment was 48hours (range 4-96), with 4 patients operated within 24hours. Five patients (42%) were treated by T-branch, 3 (25%) by custom-made fenestrated/branched endografts, 3 (25%) by parallel graft technique, and 1 (8%) by standard thoracic endovascular aortic repair covering a stenotic celiac trunk. The 30-day and in-hospital mortality was 17% and 25%, respectively. Two patients (17%) developed SCI. Cardiac and pulmonary complications were reported in 1 (8%) and 3 (25%) cases, respectively. One patient (8%) needed permanent hemodialysis. Two endoleaks (17%) were detected at the postoperative computed tomography angiography (1 low-flow gutter endoleak and 1 type III endoleak). Four patients (33%) required re-interventions within 30 postoperative days. The mean follow-up was 12months (range 1-22). No late target visceral vessels occlusion, endoleak, or reintervention occurred in this series. Overall, 7/12 (59%) patients were alive, and no cases of TAAA-related mortality occurred during follow-up. According to our results, endovascular repair of contained ruptured TAAAs is feasible by a flexible approach in selected patients with anatomical suitability and stable hemodynamic conditions. Although early mortality and morbidity are significant, with frequent reintervention necessity, subsequent follow-up is free from reinterventions and TAAA-related mortality.

Preoperative serum lactate dehydrogenase level as a predictor of major complications following thoracoscopic lobectomy: a propensity-adjusted analysis.

Despite the positive effects of a thoracoscopic approach on improving postoperative outcomes, the risk of major complications following thoracoscopic lobectomy is not negligible. We sought to assess the usefulness of the preoperative determination of serum biomarkers to refine risk stratification in this patient population. From 2009 to 2017, 626 patients (285 women, 341 men; median age: 67 years) underwent thoracoscopic lobectomy or anatomical segmentectomy for confirmed or suspected early-stage lung cancer or metastasis at our institution. Preoperative serum biomarkers, including albumin, C-reactive protein, haemoglobin and lactate dehydrogenase (LDH), were examined as predictors of postoperative cardiopulmonary complications using logistic regression analyses followed by causal inference. The 90-day mortality, cardiopulmonary complication and overall morbidity rates were 1.0%, 13.1% and 18.1%, respectively. Although serum albumin, C-reactive protein and haemoglobin were not associated with cardiopulmonary complications in regression analyses, preoperative serum LDH level emerged as an independent morbidity predictor (odds ratio 1.008, 95% confidence interval 1.002-1.013; P = 0.006). The causal inference using the covariate balancing generalized propensity score methodology demonstrated similar results and an approximately positive linear relationship between the odds of cardiopulmonary complications and preoperative serum LDH level. For every 100 U/l increase in preoperative serum LDH, a 2-fold increase in the odds of cardiopulmonary complications was observed. Our results suggest that the preoperative serum LDH level is an independent predictor of 90-day cardiopulmonary complications following thoracoscopic lobectomy or segmentectomy, even in properly selected patients. Therefore, we recommend incorporating early serum LDH measurements as a readily available method into the risk assessment process prior to major lung resection.

Single-Port Inflatable Mediastinoscopy Combined With Laparoscopic-Assisted Small Incision Surgery for Radical Esophagectomy Is an Effective and Safe Treatment for Esophageal Cancer

BackgroundWe previously developed a novel non-trans thoracic esophagectomy, the single-port inflatable mediastinoscopy combined with laparoscopy for the radical esophagectomy of esophageal cancer. The purpose of this study was to report its therapeutic efficacy and safety. MethodsFrom May 2016 to August 2017, we have completed 80 cases of radical resection of esophageal carcinoma using this novel surgical technique. The intraoperative findings and postoperative complications were reported. ResultsThe operation was successfully performed in all patients except for one patient switched from laparoscopic-assisted operation to open surgery. The mean operation duration was 191.4 ± 27 min, and the mean intraoperative blood loss was 147.3±28.9 mL. The mean number of removed lymph node was 21.9 ± 4.1. Five patients (6.4%) who had preoperative type I respiratory failure needed to stay in the intensive care unit for 24 h postoperatively. Postoperative complications included anastomotic leakage (8.9%), anastomotic stricture (21.25%), pleural effusion (9%), and hoarseness postoperative hoarseness (18.8%). The incidence of hoarseness at 3 months postoperation was reduced to 3.8%. All the complications were Clavien-Dindo grades I–III. There were no perioperative death and postoperative cardiopulmonary complications. ConclusionThese results showed that the single-port inflatable mediastinoscopy combined with laparoscopy is feasible for radical esophagectomy and possesses good therapeutic efficacy and safety.

Prognostic value of preoperative exercise capacity in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer

ObjectivesWhether or not the preoperative exercise capacity, as assessed by 6-min walk test, influences the survival of patients undergoing thoracoscopic lobectomy for lung cancer is unclear. We therefore investigated the prognostic value of the 6-min walk distance in this population. Materials and methodsThis prospective cohort study was conducted between 2005 and 2013. We studied 224 consecutive subjects with stage I-II non-small cell lung cancer who underwent thoracoscopic lobectomy. Survival was calculated by the Kaplan-Meier method. The log-rank test was used to assess the survival rate. Cox proportional hazards models were used to estimate the risk of 5-year all-cause mortality based on the preoperative 6-min walk distance with adjustment for other prognostic factors, including the age, performance status, postoperative cardiopulmonary complication, and pathological stage. ResultsThe median follow-up period was 60.8 months. During this period, 38 deaths were recorded. The 5-year overall survival rate of the subjects with a preoperative 6-min walk distance of <400 m were significantly lower than those with a 6-min walk distance of ≥400 m (65.3% vs. 88.0%; p < 0.001). A multivariate analysis showed that the 6-min walk distance was significantly associated with the overall survival after adjusting for the age and pathologic stage (hazard ratio, 2.40; 95% confidence interval, 1.20–4.79), but it did not provide additional prognostic value beyond the performance status. ConclusionThe preoperative 6-min walk distance may be useful as an additional prognostic factor for patients at an increased risk of mortality after thoracoscopic lobectomy for stage I-II non-small cell lung cancer.

Short-term Outcomes of Esophagectomies in Octogenarians—An Analysis of ACS-NSQIP

BackgroundIn the face of an increasingly aged population, surgical management in the elderly will rise. This study assesses the short-term outcomes of esophagectomies in octogenarians. Material and methodsThe National Surgical Quality Improvement Program database was queried for esophagectomy cases from 2005 to 2014. Patients aged <80 and ≥80 y were compared in univariate and multivariate analysis, controlling for confounding variables. ResultsAmong 9354 esophagectomies, 4.3% were performed in patients aged ≥80 y. Ivor Lewis was the most common approach, comprising 43% of cases. Octogenarians more frequently had dependent functional status (P < 0.0001) and cardiovascular disease (P < 0.0001), whereas younger patients were more likely obese (P < 0.0001), smokers (P < 0.0001), and have excess preoperative weight loss (P = 0.0043). Compared to younger patients, in multivariate analysis, elderly patients were noted to have increased risk of 30-d mortality (odds ratio [OR] 1.67; confidence interval [CI] 1.03-2.67), discharge to facility (OR 3.08; CI 2.36-4.02), myocardial infarction (OR 2.49; CI 1.29-4.82), and pneumonia (OR 1.47; CI 1.12-1.910). However, regardless of age, dependent functional status demonstrated the strongest association with mortality (OR 3.41; CI 2.14-6.61). Within the elderly, each additional year above 80 y old increased the risk of discharge to a facility by 17% (OR 1.17; CI 1.04-1.30). Cases requiring nongastric intestinal conduit were also more likely to suffer from early mortality (OR 2.87; CI 1.87-4.40). ConclusionsAge is independently associated with multiple adverse outcomes, including mortality, discharge to facility, and postoperative cardiopulmonary complications. Functional dependence is even more so associated with poor outcomes. Careful selection of very elderly patients is required to minimize additional risk.

Effect of anesthesia on cardiopulmonary complications in elderly patients with hip fracture

Objective: To compare the effects of different types of anesthesia on postoperative cardiopulmonary complications in patients aged 80 years and above who received unilateral hip fracture surgery. Methods: The perioperative data of patients aged 80 and above who underwent unilateral hip fracture surgery in Peking Union Medical College Hospital from July 2009 to June 2014 were collected and grouped based on the types of anesthesia including general anesthesia, neuraxial anesthesia, and peripheral nerve block. Variables were analyzed including preoperative general conditions (age, sex, type of fracture, ASA physical status classification, preoperative cardiopulmonary complications), intraoperative conditions (type of surgical procedure, operative time, blood loss, total intraoperative fluid infusion), and postoperative conditions (length of hospital stay, postoperative hospital stay, ICU stay, postoperative newly developed cardiopulmonary complications, postoperative in-hospital death, hospitalization costs). The incidences of postoperative cardiopulmonary complications of each group were analyzed and compared. Results: A total of 219 cases were finally analyzed including general anesthesia (n=46), neuraxial anesthesia (n=90) and nerve block group (n=83). Fewer cases with preoperative pulmonary complications were noticed in general anesthesia group (15 cases, 32.6%) than in neuraxial anesthesia group (45 cases, 50%) and nerve block group (47 cases, 56.6%) (χ(2)=6.912, P=0.032). No statistical differences were found between groups regarding preoperative cardiovascular complications and other variables. There were no significant differences in postoperative cardiopulmonary complications. However, the cost of hospitalization was lower in neuraxial anesthesia group (45.6±21.4) thousand RMB and nerve block group (48.2±25.8) thousand RMB compared with general anesthesia group (56.3±21.6) thousand RMB, the difference was statistically significant(F=9.951, P=0.007). Conclusions: For elderly patients undergoing unilateral hip surgery, the type of anesthesia does not affect the incidence of postoperative cardiopulmonary complications. However, neuraxial anesthesia and nerve block may reduce the cost of hospitalization.

PS02.180: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OESOPHAGO-GASTRIC CANCER SURGERY: EVALUATION OF A SINGLE-CENTRE EXPERIENCE

Abstract Background Cardiopulmonary exercise testing (CPEX) is an objective measure of functional capacity adapted to predict post-operative morbidity. CPEX may also identify optimisable cardio-respiratory comorbidity, prompting treatment modification or specialist referral. The role of CPEX in patient optimisation before oesophago-gastrectomy is yet to be evaluated. This study aims to assess the utility of CPEX in altering management and optimising patients prior to oesophago-gastrectomy. Methods All patients who underwent pre-operative CPEX testing and two phase oesophago-gastrectomy (January 2012 to January 2018) were included. All changes in patient management brought about by CPEX findings were evaluated. In addition, the role of validated risk-stratifying CPEX parameters (anaerobic threshold (AT), VO2 peak and FEV1) in predicting post-operative complications was assessed. Results 236 patients underwent surgery. Median AT and VO2 peak were 11.95(7–24)ml/kg/min and 773(403–1552)ml/min/m2 respectively. 46% (109/236) of patients (VO2 peak &gt; 800ml/min/m2) were graded ‘low risk’, 42% (99/236) ‘intermediate risk’ (VO2 peak = 600–800ml/min/m2), and 12% (28/236) ‘high risk’ (VO2 peak &lt; 600ml/min/m2) for developing post-operative cardio-pulmonary complications. Based on CPEX findings, management plans were altered in 84 patients (36%). Cardiac comorbidity was identified in 55 patients (23%) with immediate alteration of cardiac medications in 9% (21/236) and another 11% (27/236) requiring specialist cardiology review. Medication for respiratory optimisation was initiated in 3% (7/236) and formal respiratory review sought in 5% (12/236). ‘Intermediate’ and ‘high risk’ patients had similar rates of overall complication (63% vs 63%, P = 1.00), cardio-pulmonary complication (48% vs 47%, P = 0.17), anastomotic leak (11% vs 15%, P = 0.33) and 90-day mortality (6% vs 4%, P = 0.40) compared with ‘low risk’ groups. CPEX variables (AT, VO2 peak, FEV1) did not predict complications, length of critical care or overall stay on Receiver Operating Characteristic curves (AUROC &lt; 0.5) and multivariate logistic regression models. Conclusion CPEX findings changed management in 36% of patients, enabling optimisation before oesophago-gastrectomy. ‘Confounding by intention’ is a bias reducing the strength of association between test results and post-operative complications due to the propensity to medically intervene on the basis of the test findings. This study highlights the possibility that the high intervention rate may explain the poor correlation between test results and post-operative outcome. Disclosure All authors have declared no conflicts of interest.

The association between nurse staffing levels and paediatric nursing-sensitive outcomes in tertiary hospitals.

This study aimed to explore the association between paediatric nursing-sensitive outcomes and nurse staffing levels. Although previous studies have reported an association between low nursing-sensitive outcomes and high nurse staffing levels in adult populations, there are few studies on paediatric nursing-sensitive outcomes. This study used electronic Health insurance review and assessment data for all children under 18 years old admitted at 46 tertiary hospitals in Korea between 2013 and 2014. Multiple logistic regression was used to examine relationships among nurse staffing levels and 11 paediatric nursing-sensitive outcomes. Nurse staffing levels had a clear relationship with the occurrence of lower respiratory tract infection and gastrointestinal infection. Five paediatric nursing-sensitive outcomes (pneumonia, sepsis, arrest / shock / respiratory failure, wound infection and postoperative cardiopulmonary complication) showed weak relationships with nurse staffing levels. Pressure ulcers and failure to rescue had the lowest incidences in hospitals with the lowest nurse staffing levels. We demonstrated evidence for the relationships of nurse staffing levels with seven paediatric nursing-sensitive outcomes. For quality paediatric nursing care, nurse staffing improvement is required. The study results could be useful evidence for appropriateness of nursing staffing in paediatric facilities.

Preoperative risk assessment with computed tomography in patients undergoing lung cancer surgery.

Although whole lung computed tomography (CT) is included in the routine workup before lung cancer surgery, it is not utilized to assess the preoperative pulmonary function. Two hundred ninety patients (development cohort) who underwent lung lobectomy for cancer in our institute and another 100 patients (validation cohort) who subsequently underwent the same operation in a referral hospital were included. The total lung volume (TLV) and emphysematous lung volume (ELV) were obtained by quantitative CT. The TLV was higher in patients with a smoking history than in those without. The ELV to the TLV was higher in elderly patients than in younger patients. The regression equation for forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were developed using CT-derived variables, together with sex, age, height, and smoking habit, by a multiple regression analysis in the development cohort. The regression equation-based FVC and FEV1 were significantly correlated with the actual FVC and FEV1 in the development cohort, as well as in the validation cohort. The predicted postoperative FEV1 (ppo%FEV1) calculated based on the regression equation was also correlated with the postoperative FEV1 value obtained by the conventional method (R=0.53), and the regression equation-based ppo%FEV1 was a significant predictor of postoperative cardiopulmonary complications (P=0.02). Whole lung CT can be used to assess the preoperative pulmonary function in patients undergoing lobectomy for cancer. This method may be helpful in preoperative risk assessment, particularly in patients who have difficulty in implementation of spirometry.

Short-term postoperative complications and prognostic factors in patients with adenocarcinoma of the esophagogastric junction.

BackgroundThe study was conducted to investigate the short‐term complications and prognostic factors in patients with esophagogastric junction adenocarcinoma (EGJA).MethodsThis retrospective study included 110 EGJA patients who underwent surgery from January 2010 to November 2012 at The First Affiliated Hospital of BengBu Medical College. The overall survival and short‐term complications were analyzed according to the patients’ clinical characteristics.ResultsThe incidence of postoperative cardiopulmonary complications was significantly higher in patients with preoperative cardiopulmonary disease or elderly patients (P < 0.05). Four cases of upper margin cancer residue were detected using the abdominal approach and three using the thoracic approach, which indicated that the cancer residue margin was related to surgical approach. The overall five‐year survival rate was 34.3% and statistically differed according to pathological stage and en block resection (P all < 0.05). Cox regression analysis showed that lymph node metastasis (P < 0.05) and the extent of tumor invasion (P < 0.05) were independent prognostic factors.ConclusionElderly patients with preoperative cardiopulmonary disease had an increased risk of developing postoperative cardiopulmonary complications. Lymph node status and depth of tumor invasion were independent factors related to patient prognosis.

Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study

BackgroundThe purpose of our study was to estimate the influence of estimated intraoperative blood loss (EIBL) on postoperative cardiopulmonary complications (PCCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC).MethodsWe conducted a single-center retrospective analysis on the clinical data of consecutive patients in our institution between April 2015 and February 2016. Demographic differences between PCC group and non-PCC group were initially assessed. Receiver operating characteristic (ROC) analysis was performed to determine the threshold value of EIBL for the prediction of PCCs. Demographic differences in the PCC rates and length of stay between two groups of patients divided by this cutoff were further evaluated. A multivariable logistic-regression model involving the clinicopathological parameters with P-value< 0.05 was finally established to identify independent risk factors for PCCs.ResultsA total of 429 patients with operable NSCLC were included and 80 of them developed PCCs (rate = 18.6%). The mean EIBL in PCC group was significantly higher than that in non-PCC group (133.3 ± 191.3 vs. 79.1 ± 107.1 mL; P < 0.001). The ROC analysis showed an EIBL of 100 mL as the threshold value at which the joint sensitivity (50.0%) and specificity (73.4%) was maximal. The PCC rate in patients with EIBL≥100 mL was significantly higher than that in patients with EIBL< 100 mL (30.1 vs. 13.5%; P < 0.001). Both the length of stay and chest tube duration were significantly prolonged in the patients with EIBL≥100 mL. Finally, EIBL≥100 mL was identified to be predictive of PCCs by multivariable logistic-regression analysis (odds ratio = 3.01; 95% confidence interval = 1.47–6.16; P = 0.003).ConclusionsEIBL serves as a significant categorical predictor for cardiopulmonary complications following VATS lobectomy for NSCLC. Thoracic surgeons should minimize the EIBL and strive for the ‘bloodless’ goal to optimize surgical outcomes.

Effects of inhalation and intravenous anesthesia on intraoperative cardiopulmonary function and postoperative complications in patients undergoing thoracic surgery.

There is a high incidence of postoperative cardiopulmonary complications after thoracic surgery with one lung ventilation (OLV), the effect of general anesthetics on intraoperative cardiopulmonary function and postoperative complications is still unclear. We searched the Embase, PubMed, Cochrane Library, Springer, Wiley, CNKI, VIP and Wanfang databases for randomized controlled trials (RCTs) in which inhalation anesthesia and intravenous anesthesia were compared; intraoperative cardiopulmonary function and postoperative complications were assessed in patients undergoing thoracic surgery with intraoperative one-lung ventilation (OLV). Twenty-three RCTs with a total of 1349 patients were included. Compared with intravenous anesthesia, inhalation anesthesia significantly increased pulmonary shunt fraction (Qs/Qt) (mean: 5.72, 95% CI: 3.93 to 7.51, P<0.0001), and improved Cardiac Index (CI) (mean difference [MD]: 0.19, 95% CI: 0.10 to 0.28, P<0.0001), but decreased Oxygenation Index (OI) during OLV intraoperatively (MD: -27.37, 95% CI: -43.92 to -10.82, P=0.001). Inhalation anesthesia could reduce postoperative pulmonary complications (RR: 0.47, 95% CI: 0.33 to 0.66, P<0.0001), but did not reduce postoperative cardiac adverse events (P>0.05). Inhalation anesthesia can preserve intraoperative cardiac function and reduce postoperative pulmonary complications in patients undergoing thoracic surgery with OLV; although it decreases intraoperative pulmonary function, inhalation anesthesia may be superior to intravenous anesthesia in thoracic surgery. Publication bias existed in some included studies, and the sample size was not large enough in CI and cardiac adverse events.

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population.

Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

Predicting postoperative cardio-pulmonary complications by a test of stair climbing.

To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Cohort study. The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge. Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed < 1 flight. All-cause cardiopulmonary complications rate was 26 %. The most frequent complication was lobar atelectasis, followed by bronchospasm and acute MI. The complication rate was 22.8% in those able to climb 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems, i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.

Degree of pulmonary fissure completeness can predict postoperative cardiopulmonary complications and length of hospital stay in patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer

To estimate the effects of pulmonary fissure completeness on postoperative cardiopulmonary complications (PCCs) and hospital stay in patients undergoing video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer. We performed a single-centre retrospective analysis based on the prospectively maintained data of our institution during the study period. Demographic differences between the PCC group and the non-PCC group were initially examined. Then, the patients were classified into 3 groups according to their fissure sum averages (FSAs: 0 ≤ FSA ≤ 1, 1 < FSA ≤ 2, 2 < FSA ≤ 3) calculated by fissure development scores. The differences in PCC incidences and hospital stay between these 3 groups were further evaluated. Finally, FSA > 1 was determined as the cut-off to indicate the degree of pulmonary fissure completeness and involved into a multivariate logistic regression model to identify the predictors for PCCs. In total, 528 patients with Stage I to Stage II non-small-cell lung cancer were enrolled. There were 343 patients with 0 ≤ FSA ≤ 1, 105 patients with 1 < FSA ≤ 2 and 80 patients with 2 < FSA ≤ 3. Pulmonary complication rate in patients with 1 < FSA ≤ 2 (25.7% vs 14.3%; P = 0.006) and with 2 < FSA ≤ 3 (33.8% vs 14.3%; P < 0.001) was significantly higher than that in patients with 0 ≤ FSA ≤ 1. No difference was found in cardiovascular complication rate between these groups (P = 0.22). The Kaplan-Meier analysis showed that the length of hospital stay and the length of chest tube drainage in patients with 1 < FSA ≤ 2 and with 2 < FSA ≤ 3 were significantly longer than those in patients with 0 ≤ FSA ≤ 1. Incomplete pulmonary fissure (FSA > 1) was a strong independent predictor for PCCs (odds ratio = 2.12; P = 0.002) in the multivariate analysis. The degree of pulmonary fissure completeness can predict the PCCs and the length of hospital stay following video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer.

Don’t Ignore My Snore: Reduce Perioperative Complications Related to Obstructive Sleep Apnea

Obstructive sleep apnea (OSA), a condition associated with decreased muscle tone in the airway, has been linked to postoperative complications. Perioperative patients were screened for OSA risk, yet no guideline was enforced. A chart audit revealed a high percentage of patients screened high-risk for OSA had postoperative cardiopulmonary complications.