Incidence Of Cardiopulmonary Complications Research Articles

Intravenous Lidocaine Significantly Reduces the Propofol Dose in Elderly Patients Undergoing Gastroscopy: A Randomized Controlled Trial.

ObjectivePropofol-based sedation has been widely used for gastroscopy, but the risk of respiratory suppression in elderly patients should not be overlooked. Intravenous (IV) lidocaine during surgery can reduce the demand for propofol and the incidence of cardiopulmonary complications. We examined whether IV lidocaine reduces the dose of propofol and the occurrence of adverse events during gastroscopy in elderly patients.MethodsWe conducted a prospective, single-center, double-blind randomized controlled trial in elderly patients aged ≥65 years with ASA I-II. Subjects were randomly assigned to the lidocaine group (Group L, n=70), who received IV 1.5 mg kg−1 lidocaine followed by a continuous infusion of 4 mg kg−1 h−1 lidocaine, or the normal saline group (Group N, n=70), who received an equal volume of saline in the same way.ResultsIV lidocaine reduced the total and maintenance propofol dose in Group L (p<0.001), with no significant effect on the induction dose. The incidence of intraoperative hypoxia (p=0.035), emergency airway management events (p=0.005), duration of gastroscopy (p<0.05), consciousness recovery time (p<0.001), and postoperative pain (p=0.009) were all reduced in Group L. Patient (p=0.025) and gastroscopist (p=0.031) satisfaction was higher in Group L. Intraoperative hemodynamic parameters, the respiratory rate, the incidence of sedation-related events and anesthesiologist satisfaction were similar between the two groups.ConclusionIV lidocaine can significantly reduce the amount of propofol, the incidence of hypoxia and postoperative pain during gastroscopy in elderly patients, with a higher patient and gastroscopist satisfaction.

Morbidity and mortality of lung resection candidates defined by the American College of Chest Physicians as 'moderate risk': an analysis from the European Society of Thoracic Surgeons database.

The American College of Chest Physicians functional guidelines classify patients with predicted postoperative forced expiratory volume in 1 s or predicted postoperative carbon monoxide lung diffusion capacity <60% and with maximal oxygen consumption (VO2max) between 10 and 20 ml/kg/min in a heterogeneous category broadly defined as 'moderate risk' with variable morbidity and mortality. Data to support this statement are lacking. Using the European Society of Thoracic Surgeons database, our goal was to test this definition by evaluating the morbidity and mortality of those patients falling into this class. All patients who had anatomical lung resection for lung cancer (2007-2019) and were deemed of moderate risk were identified in the European Society of Thoracic Surgeons database. Cardiopulmonary morbidity and 30-day mortality of these patients were assessed by the type of operation. A total 2016 patients were identified. The incidence of cardiopulmonary complications in this group was 21% after lobectomy (294/1435), 29% after bilobectomy (33/112), 22% after pneumonectomy (72/333) and 16% after segmentectomy (22/136) (analysis of variance P = 0.07). The 30-day mortality was 3.4% after lobectomy (49/1435), 8.9% after bilobectomy (10/112), 7.8% after pneumonectomy (26/333) and 3.7% after segmentectomy (5/136) (analysis of variance P = 0.0005). The 30-day mortality rate was 1.6-fold higher in patients with a VO2max between 10 and 15 ml/kg/min compared to those with a higher VO2max [49/861 (5.7%) vs 41/1155 (3.5%); P = 0.022]. For operations that were less extensive than a pneumonectomy and were performed by minimally invasive surgery, there was no difference in mortality between patients with a VO2max between 10 and 15 ml/kg/min and those with a higher VO2max [7/181 (3.8%) vs 11/272 (4.0%); P = 0.92]. On the other hand, after open surgery, the mortality of patients with a lower VO2max (10-15 ml/kg/min) was higher than that of those with a higher VO2max [26/501 (5.1%) vs 20/721 (2.8%); P = 0.034]. Linear regression adjusting for the extent and access of the operation confirmed that within the moderate-risk group a VO2max <15 ml/kg/min was associated with higher mortality (P = 0.028; odds ratio 1.61; 95% confidence interval 1.1-2.5). Morbidity and mortality rates found in this study are not negligible and reinforce the recommendation to ensure careful patient discussion and informed decision-making prior to lung cancer resection surgery.

Safety of Continuous Postoperative Pulse Oximetry Monitoring Without Obstructive Sleep Apnea Screening in > 5000 Patients Undergoing Bariatric Surgery.

Obstructive sleep apnea (OSA) is common but often undiagnosed in obese patients undergoing bariatric surgery, and is associated with increased risk of cardiopulmonary complications. The aim of this study is to evaluate the safety of continuous postoperative pulse oximetry (CPOX) without preoperative OSA screening in bariatric patients. Retrospective, single-center cohort study of all consecutive patients who underwent bariatric surgery between 2011 and 2017. All patients were postoperatively monitored with CPOX and received oxygen supplementation. Patients with no history of OSA (the "CPOX" only group) were compared with patients with adequately treated OSA as a reference group. The primary outcome was the incidence of cardiopulmonary complications within 30 days after surgery. Secondary outcomes included overall 30-day complications, mortality, intensive care unit (ICU) admissions, readmissions, and length of stay. In total, 5682 patients were included, 89.6% (n = 5089) had no history of OSA, 10.4% (n = 593) had adequately treated OSA. Cardiopulmonary complications occurred in the CPOX group and OSA group in 0.6% (n = 31) and 0.8% (n = 5), respectively (p = 0.171). No mortality occurred due to cardiopulmonary complications. In both groups, one patient required ICU admission for respiratory failure (p = 0.198). Non-cardiopulmonary complications occurred in 6.4% in the CPOX group and 7.8% in the OSA group (p = 0.792). Mortality, ICU admissions, readmissions, and length of stay were not significantly different between groups. These data suggest that CPOX monitoring without preoperative OSA screening is a safe and effective strategy in perioperative care of bariatric patients. Future studies are needed to assess whether this strategy is also cost-effective.

Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database.

To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. Retrospective analysis on 52982 anatomic lung resections registered in the ESTS database (July 2007-31 December 2017) (6587 pneumonectomies and 46395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

Clinical Manifestation and Incidence of Cardiopulmonary Complications in Early Systemic Sclerosis Patients with Different Antibody Profiles.

BackgroundThere has been no prior inception cohort study comparing clinical manifestations and incidence rate (IR) of cardiopulmonary involvement among early systemic sclerosis (SSc) patients by difference in autoantibody profiles. We compared the differences in the clinical presentation at study entry and cumulative organ complications at last visit, as well as the IR of cardiopulmonary complications between anti-topoisomerase I antibody-positive SSc patients (pATA), ATA-negative (nATA), and the positive anti-centromere antibody patients (pACA).MethodsAn inception cohort of early diagnosis SSc patients (disease duration ≤ 3 years) seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, between January 2010 and June 2016, was studied. SSc patients who had follow-up duration as less than 1 year and those diagnosed with an overlap syndrome were excluded. All participants underwent electrocardiography (ECG), echocardiography, and high-resolution computed tomography (HRCT) at the study entry and then annually.ResultsA total of 114 patients (90 diffuse cutaneous SSc (dcSSc), 69 women) with mean (standard deviation, SD) disease duration of 11.7 (8.8) months at cohort entry and an observational period of 3.8 (1.6) years, were recruited. There were 89 patients (78.1%) with pATA, 18 (15.8%) with nATA, and 7 (6.1%) with pACA. At enrollment, both pATA and nATA groups had a higher prevalence of dcSSc subtype, and interstitial lung disease (ILD) when compared with the pACA group. At the last visit, the pATA group had a higher cumulative prevalence of digital ulcers, joint contracture and tendon friction rub than the other groups. Both the pATA and nATA groups had a significantly higher IR of ILD compared to the pACA group (54.9 and 57.8 vs. 6.3 per 100 person-years). During the study period, no suspected myositis, systolic pulmonary artery pressure (sPAP) ≥ 50 mm Hg or cardiac complications was observed in the pACA group.ConclusionsIn our study cohort, the majority of which were dcSSc subtype with pATA, it was found that the presence of SSc-specific autoantibodies was associated with a distinctive clinical presentation and cumulative internal organ involvement, even in the early phase of the disease. Cardiopulmonary complications were rarely seen in the pACA group; whereas ILD complications were very common in both the pATA and nATA groups. A further study into the association of autoantibodies in nATA patients with ILD complications is needed.

Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

ObjectivesThe aim of the study was to identify whether ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) as part of the preoperative functional workup was an independent prognostic factor for short and long-term survival after major lung resection. Patients and methods974 consecutive patients undergoing lobectomy (n = 887) or segmentectomy (n = 87) between April 2014 to March 2018 were included. 209 (22%) underwent CPET, and pulmonary function tests and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis. ResultsAmong the patients with measured VE/V CO2, the incidence of cardiopulmonary complications in patients with high VE/V CO2 slope (>40) was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p = 0.19). The 90-day mortality in patients with high VE/V CO2 slope (n = 8) was 16% vs. 5% (n = 6) in those with lower slope values (p = 0.03). No overall difference in 2-year mortality was identified between the two groups (VE/VCO2 > 40: 70% (54–80) vs. VE/VCO2 ≤ 40: 72% (63–80), log-rank test, p = 0.39). In a Cox regression analysis VE/VCO2 values were associated with poorer 2-year survival (HR 1.05, 95% CI 1.01–1.10, p = 0.030). ConclusionsWe found that VE/V CO2 slope was an independent prognostic factor for the 90-day mortality and 2-year survival after anatomic pulmonary resection. This finding may assist during the multidisciplinary treatment decision-making process in high-risk patients with lung cancer.

Enhanced recovery pathway versus standard care in patients undergoing video-assisted thoracoscopic lobectomy

ObjectiveThe objective of this study was to compare outcomes after video-assisted thoracoscopic lobectomy or segmentectomy before and after introduction of an enhanced recovery program. MethodsData from 600 patients undergoing video-assisted lobectomy or segmentectomy between April 2014 and January 2017 were analyzed. A comparative analysis was performed between patients undergoing operation before (365 patients) and after (235 patients) the start of the enhanced recovery program. The incidence of cardiopulmonary complications and 30-day and 90-day mortality, postoperative length of stay, and 30-day and 90-day hospital readmission rates were evaluated. Risk-adjusted cardiopulmonary morbidity and 30-day mortality were calculated for each group and compared. ResultsThe 2 groups had a similar postoperative length of stay (enhanced recovery pathway median 5 days vs pre–enhanced recovery pathway 4, P = .44), cardiopulmonary complication rates (enhanced recovery pathway 22.6% vs pre–enhanced recovery pathway 22.4%, P = .98), 30-day mortality rates (enhanced recovery pathway 3.8% vs pre–enhanced recovery pathway 2.2%, P = .31), and 90-day mortality rates (enhanced recovery pathway 4.7% vs pre–enhanced recovery pathway 3.0%, P = .37). No differences were noted in terms of 30-day (enhanced recovery pathway 7.2% vs pre–enhanced recovery pathway 7.4%, P = .94) or 90-day readmission rates (enhanced recovery pathway 9.8% vs pre–enhanced recovery pathway 12.3%, P = .34). The risk-adjusted cardiopulmonary morbidity rates were similar in the 2 periods (P = .76), whereas the risk-adjusted 30-day mortality was higher in the enhanced recovery pathway period compared with the pre–enhanced recovery pathway mortality (P = .0004). ConclusionsWe found no benefit conferred by the enhanced recovery program on outcomes such as cardiopulmonary complications, 30- and 90-day mortality, length of stay, and readmissions. Enhanced recovery program elements may be insufficiently different than previous standards of perioperative care to confer detectable benefits in our settings.

Effect of video-assisted thoracoscopic operation on postoperative cardiopulmonary complications in elderly patients with non-small cell lung cancer

Objective To compare the incidence of cardiopulmonary complications between treatment of video assisted thoracoscopic operation and traditional thoracotomy operation in elderly patients with non-small cell lung cancer. Methods 122 cases of elderly patients with non-small cell lung cancer were treated in our hospital from Mar 2010 to Jun 2014, and randomly divided into observation group (therapeutic lobectomy by video-assisted thoracoscopic operation) and control group (therapeutic lobectomy by traditional thoracotomy operation) (n=61, each). The postoperative cardiopulmonary complications and relevant indexes of cardiopulmonary function were analyzed and compared between the two groups. Results Before operation, there was no significant difference in the relevant indexes of cardiopulmonary function between the two groups (P>0.05). After operation, the forced expiratory volume in one second (FEV1) and maximal ventilatory volume (MMV) were higher and the heart rate was lower in observation group than in control group (t=3.682, 2.243, 5.677, all P<0.05). The incidence of cardiopulmonary complication was lower in observation group than in control group (13.1% vs. 27.9%, χ2=4.075, P=0.044). Conclusions Video-assisted thoracoscopic operation is better for the recovery of cardiopulmonary function, and can reduce cardiopulmonary complication in elderly patients with non-small cell lung cancer. Key words: Thoracoscopes; Cacinoma, non-small-cell lung; Postoperative complications

Evaluation of surgical risk for elderly patients with gastric cancer

Objective To evaluate the clinical characteristics and surgical risks for elderly patients with gastric cancer. Methods The clinical data from 607 patients, who received surgical therapy for gastric cancer between January 2006 and December 2009, were retrospectively analyzed.Among them, 267 patients were over 65 years of age, and the other 340 patients (≤65 years of age)were served as control. Complete surgical resection was done by doctors in same group. The preoperative complications such as cardiopulmonary disease and post-operative complications as well as pathologic patterns were compared between two groups. Results Coexisted diseases were found more in elderly patients than in controls (68.91% vs 31.63 %, P＜0.01). Whereas there was no significant difference between two groups with respect to post-operative complication [28. 19% (75/267)vs 25.59 % (87/340)]. However, the incidence of cardiopulmonary complications, especially pulmonary infection, was higher in elderly patients than in controls (17.23% vs 5.29% ,P＜0.01). The digestive tract complications were related to the pattern of radical operation. Post-operative complication occurred less in patients treated with D1 radical operation than those with D2 and D3 radical operation.Conclusions The incidence of post-operative complication in elderly patients with gastric cancer was closely related to the surgical method. The elderly patients may has less complications if they were operated with D1 radical method which can reduce risk of complication and improve the quality of life. Key words: Stomach neoplasms; Surgery; Complication; Age

Role of stair-climbing test in predicting postoperative cardiopulmonary complications in elderly patients with biliary diseases

One hundred and twenty-six patients above 80 years old with biliary diseases undergoing operations in Shaoxing People’s Hospital from Jan. 2002 to Jan. 2007 were analyzed retrospectively. All patients performed a preoperative stair-climbing test, and the risks for cardiopulmonary complications were evaluated with pairmatching and linear correlations analysis between stairclimbing height (h) and left ventricular ejective factor (EF), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). There was a significant difference in the incidence of cardiopulmonary complications among different stair-climbing heights. Stair-climbing heights were positively related with EF, FVC and FEV1. This suggests that the stair-climbing test is an effective and simple method for predicting cardiopulmonary complications in elderly patients with biliary diseases.

Comparison of iridium implant boost versus electron boost as a component of breast conservation treatment for early-stage breast carcinoma.

Abstract Abstract #5144 Background: Breast conservation treatment includes lumpectomy followed by definitive radiation therapy, with radiation delivered to the whole breast followed by tumor bed boost. Currently, the boost is typically delivered by electron beams, but was previously delivered by iridium-192 implants. With re-emergence of implant radiotherapy techniques in current practice, long-term outcomes of both boost techniques are important.&amp;#x2028; Methods: From 1977 to 1983, 141 patients with early-stage breast cancer were treated with iridium-192 boost after whole breast radiation. These patients were matched 1:1 to 141 patients who received electron boost from 1980 to 1990. Most implant patients were treated before widespread electron availability. Matching criteria included age at diagnosis, final pathologic margin status, pathologic tumor stage, and pathologic nodal stage. All patients had AJCC Stage I or II invasive breast carcinoma, had surgical excision of the primary tumor, and underwent definitive radiation to at least 60 grays. Chemotherapy was administered to 30 implant patients and 41 electron patients (p=0.014), and hormonal treatment to 3 implant patients and 12 electron patients (p=0.032). These systemic treatment variations were expected due to treatment era differences. Median follow-up was 16.7 years for implant patients (range 0.7-28.5) and 12.6 years for electron patients (range 1.4-25.4) (p&amp;lt;0.001).&amp;#x2028; Results: Electron boost patients were more likely to have excellent/good cosmesis versus fair/poor cosmesis than implant boost patients. At 1-year follow-up, this was significant (p=0.014). This trend continued, with odds ratio of having excellent/good cosmesis versus fair/poor cosmesis in implant patients compared to electron patients being 0.29 after 5 years (95% CI 0.027-1.38, p=0.114) and 0.24 after 10 years (95% CI 0.005-1.93, p=0.266).&amp;#x2028; Incidence of all complications evaluated did not differ between the two groups (all p≥0.07). Incidence of breast fibrosis was 3% per year in implant patients and 4% per year in electron patients (p=0.17). In total, breast fibrosis developed in 41% of implant patients and 16% of electron patients. Incidence of infection was 14% per year in the implant group and 6% per year in the electron group (p=0.09). In total, infection developed in 7% of implant patients and 9% of electron patients. Incidence of rib fracture was 2% per year in both groups (p=0.8). Incidence of cardiopulmonary complications was 4% per year in implant patients and 3% per year in electron patients (p=0.7). Incidence of non-cardiac vascular complications was 4% per year in both groups (p=0.1). Incidence of neuropathy was 4% per year in implant patients and 1% per year in electron patients (p=0.07).&amp;#x2028; Conclusions: Patients treated with electron boost were more likely than those treated with implant boost to have excellent/good cosmesis, though this observation did not reach statistical significance at 5- and 10-year follow-up. Complication rates did not differ significantly between the groups with long-term follow-up. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5144.

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

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. Observational study of patients who underwent pneumonectomy. Potential risk factors were analyzed from a local database including all thoracic surgical cases. A university hospital and a chest medical center. 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). 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). 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.

Cancer of the esophagus in young adults.

Clinicopathological features and survival data of squamous cell carcinoma of the esophagus were analyzed from the viewpoint of age differences in 453 patients treated at the Tata Memorial Hospital, Bombay, India. Two groups were studied: group A, aged 35 years or less; and group B, aged above 35 years. There was no significant difference among the two groups with regard to sex distribution, site and length of the tumor, operability, morphology, histological grade, vascular and lymphatic invasion, and lymph node metastasis. The primary lesion was more advanced and the rate of incomplete resections was higher in younger patients. The incidence of cardiopulmonary complications and postoperative deaths was significantly lower in younger patients. Recurrence of the disease following complete resection was more frequent in the younger age group (chi 2 = 2.61; P = .1063), although the pattern of recurrence remained the same in both groups. Disease-free survival in younger patients following complete resection of the tumor was poorer as compared to the older patients, but the difference is statistically not significant (chi 2 = 1.882; P = .1701). These findings suggest either a delayed diagnosis or a biologically sinister disease in the younger group; further studies of the two groups vis-a-vis their biologic parameters (DNA ploidy, etc.) are in progress and will form the subject of another communication.