Incidence Of Postoperative Cardiopulmonary Complications Research Articles

Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial

IntroductionCardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to...

Interpretable prediction of cardiopulmonary complications after non-small cell lung cancer surgery based on machine learning and SHapley additive exPlanations

IntroductionLung cancer is a prevalent malignancy globally, with approximately 20% of patients developing cardiopulmonary complications after lobectomy. In order to prevent complications, an accurate and personalized method based on machine learning (ML) is required. MethodsDuring the period of 2017–2021, a retrospective analysis was conducted on the medical records of patients who had undergone lobectomy for non-small cell lung cancer (NSCLC). We performed logical regression, decision tree (DT), random forest (RF), gradient boost DT, and eXtreme gradient boosting analyses to establish an ML model. The ten-fold cross-validation was used to evaluate the performance of multiple ML models based on various evaluation metrics, including accuracy, precision, recall, F1 score, and area under the receiver operating (AUC). Additionally, we also calculated the Kappa value of these model. Each model used grid search to optimize hyper-parameters and then used the interpretability method to provide explanations for the model's Decisions. ResultsThe study included 718 eligible patients, among whom the incidence of postoperative cardiopulmonary complications was 20.89%. The RF model showed the best comprehensive performance among all models, and its ten-fold cross-validation accuracy, precision, recall, F1 score, and AUC were (OR and 95% confidence interval [CI]) 0.786 (0.738–0.834), 0.803 (0.735–0.872), 0.738 (0.678–0.797), 0.766 (0.714–0.818), 0.856 (0.815–0.898), respectively. The kappa value of the RF model was 0.696 (0.617–0.768). The SHAP method showed that gender, age, and intraoperative blood loss were closely associated with postoperative cardiopulmonary complications. ConclusionThe application of ML methods for predicting postoperative cardiopulmonary complications based on clinical data of patients with NSCLC showed a good performance. The results indicate that ML combined with the SHAP individualized interpretation method has practical clinical value.

Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma

BackgroundTransthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect.MethodData of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer.ResultsA total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomy、perioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 ± 0.52 h、The surgical blood loss was 142 ± 36.50 ml、The amount of dissected lymph nodes were 21.6 ± 4.2、The duration of drainage tube was 5.8 ± 2.5 days、The duration of time on the ventilator was 6.5 ± 3.4 h、The length of stay in ICU was 1.2 ± 0.4 days、The postoperative hospital stay was 12.6 ± 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully.Conclusion:Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.

Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer

The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function. This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function. The data were obtained from a prospective cohort study called Coordinate Approach to Cancer Patient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups. The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95%CI, 2.37-44.36), 5.65 (95%CI, 1.39-22.90), and 7.84 (95%CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95%CI, 1.37-17.93). Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC. ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.

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.

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.

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.

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.

Long acting \u03b22-adrenocepter agonists are not associated with atrial arrhythmias after pulmonary resection

BackgroundLong-acting β2-adrenoceptor agonists have been shown to increase the risk of atrial arrhythmias in patients with stable chronic obstructive pulmonary disease. The aim of this study was to investigate whether perioperative long-acting β2-adrenoceptor agonists treatment would increase the risk of postoperative atrial arrhythmias after lung cancer surgery in chronic obstructive pulmonary disease patients.MethodsWe retrospectively analyzed 174 consecutive chronic obstructive pulmonary disease patients with non-small-cell lung cancer who underwent lobectomy or segmentectomy. The subjects were divided into those with or without perioperative long-acting β2-adrenoceptor agonists treatment. Postoperative cardiopulmonary complications were compared between the two groups.ResultsThere were no statistically significant differences between the perioperative long-acting β2-adrenoceptor agonists treatment group and the control group in the incidence of postoperative atrial arrhythmias (P = 0.629). In 134 propensity-score–matched pairs, including variables such as age, gender, comorbidities, smoking history, operation procedure, lung-cancer staging, and respiratory function, there were no significant differences between the two groups in the incidence of postoperative cardiopulmonary complications, including atrial arrhythmias.ConclusionsPerioperative administration of long-acting β2-adrenoceptor agonists might not increase the incidence of postoperative atrial arrhythmias after surgical resection for non-small-cell lung cancer in chronic obstructive pulmonary disease patients.

Long-Term Impact of Postoperative Complications on Cancer Recurrence Following Lung Cancer Surgery.

Postoperative complications are associated with poor cancer-specific survival in various types of cancer surgery. Recent studies suggest that systemic inflammation induced by surgical trauma can accelerate the adhesion of circulating tumor cells to the vascular endothelium of distant organs, resulting in early cancer recurrence. We investigated the impact of postoperative cardiopulmonary complications on cancer recurrence following lung cancer surgery. From a prospective database of 675 consecutive patients who underwent curative surgery for lung cancer between 2007 and 2012, the incidence of postoperative cardiopulmonary complications, white blood cell counts, and C-reactive protein levels were evaluated in the acute phase after surgery. Four patients had both cardiovascular and respiratory complications. The remaining 671 patients were divided into 3 groups: patients without cardiopulmonary complications; those with cardiovascular complications; and those with respiratory complications. The incidence of cancer recurrence was compared among the three groups. Postoperative cardiovascular or respiratory complications were identified in 94 (14%) or 25 (4%) patients, respectively. Postoperative white blood cell counts and C-reactive protein levels were significantly higher in those with postoperative respiratory complications than in those without. There was a significantly higher incidence of cancer recurrence in those with postoperative respiratory complications than in those without (48.0 vs. 16.8%; p<0.0001). Multiple regression analysis adjusted for age, sex, and pathological staging showed that the incidence of postoperative respiratory complications was a significant predictor of cancer recurrence. The presence of respiratory complications following lung cancer surgery was a significant predictor of cancer recurrence.

Cardiopulmonary exercise testing versus spirometry as predictors of cardiopulmonary complications after colorectal surgery

To determine the predictive value of spirometry and cardiopulmonary exercise testing (CPET) preoperatively in patients scheduled to undergo elective colorectal surgery. We compared the preoperative results with the incidence of postoperative cardiopulmonary complications. A total of 103 patients were scheduled to undergo preoperative CPET and spirometry; 14 patients did not attend their appointments and another 20 were unable to perform the test. In all, 69 patients (median age 60 years (range 25–85), 35 males) successfully completed cycle ergometry and lung function tests. Forced expiratory volume in 1 s (FEV1), percent forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC)) and anaerobic threshold (AT) were measured. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). Postoperative cardiopulmonary complications developed in 8 of the 69 patients (12 %). Thirty day mortality was 3 %. AT was significantly higher in group A (mean AT = 13.8; SD ± 3.0; range = 8.1–20.8) than in group B (mean = 10.91; SD ± 3.0; Range = 7.9–12), (p = 0.0006). Spirometric pulmonary function tests (FEV1, p = 0.09) and (FEV1/FVC, p = 0.08) showed no intergroup differences. The median hospital length of stay (HLOS) was significantly higher in the group of patients that suffered cardiopulmonary complications (p = 0.0282). CPET allows the prediction of postoperative cardiopulmonary complications which cannot be anticipated by spirometry. Early detection of high risk patients facilitates the planning of patient specific management strategies which are likely to improve outcome through invasive monitoring and optimisation of cardio-respiratory function.

RETRACTED ARTICLE: Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery

A new diagnosis of chronic obstructive pulmonary disease is often made during the evaluation of patients requiring lung cancer surgery. The objective of the present study was to evaluate the clinical effects of inhaled tiotropium on the postoperative cardiopulmonary complications in patients with untreated chronic obstructive pulmonary disease requiring lung cancer surgery. A retrospective study involving 104 consecutive patients with moderate to severe chronic obstructive pulmonary disease who underwent a lobectomy for lung cancer at two specialized thoracic centers between April 2008 and October 2011 was performed. The results were compared between patients who did and did not receive inhaled tiotropium during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. The postoperative white blood cell counts and C-reactive protein levels as biomarkers of inflammation were also examined. The incidence of postoperative cardiopulmonary complications was significantly lower in the tiotropium group than in the control group (18 vs. 48 %, P = 0.001). Patients in the tiotropium group also showed significantly lower white blood cell counts and C-reactive protein levels postoperatively. Inhaled tiotropium treatment during the perioperative period had a prophylactic effect on postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery.

Retracted: Low-dose human atrial natriuretic peptide for the prevention of postoperative cardiopulmonary complications in chronic obstructive pulmonary disease patients undergoing lung cancer surgery

Lung cancer patients with chronic obstructive pulmonary disease are at an increased risk of respiratory and cardiovascular complications after pulmonary resection. The objective of the present study was to evaluate the clinical effects of low-dose human atrial natriuretic peptide (hANP) on postoperative cardiopulmonary complications in untreated chronic obstructive pulmonary disease patients undergoing lung cancer surgery. Of 824 patients who underwent an elective pulmonary resection procedure for lung cancer in two specialized thoracic centres between 2008 and 2011, 202 consecutive patients who had airflow limitation before surgery were included in this retrospective study. The results were compared between patients who did and those who did not receive hANP during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. Postoperative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined. Furthermore, propensity score matching analysis was used to reduce treatment selection bias from patient characteristics. The incidence of postoperative cardiopulmonary complications was significantly lower in the hANP group than in the control group (14 vs 36%, P < 0.01). The propensity score matching analysis confirmed the significantly decreased frequency of postoperative cardiopulmonary complications in the hANP group. Patients in the hANP group showed significantly lower WBC counts and serum CRP levels postoperatively. Treatment with hANP during the perioperative period had a prophylactic effect against postoperative cardiopulmonary complications in chronic obstructive pulmonary disease patients undergoing lung cancer surgery.

Effects of low-dose human atrial natriuretic peptide for preventing post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer

The objective of the present study was to evaluate the clinical effects of human atrial natriuretic peptide (hANP) on post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer. A retrospective study involving 44 consecutive patients aged ≥75 years who had elevated pre-operative B-type natriuretic peptide levels (≥30 pg/ml) and underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centres between April 2008 and March 2010. Results were compared between the patients who did and did not receive hANP during the perioperative period. The primary endpoint was the incidence of post-operative cardiopulmonary complications. Post-operative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined. The incidence of post-operative cardiopulmonary complications was significantly lower in the hANP group than that in the control group (26 vs. 86%, P < 0.0001). Patients in the hANP group showed significantly lower WBC counts and serum CRP levels post-operatively. Continuous infusion of low-dose hANP during lung cancer surgery had a prophylactic effect on post-operative cardiopulmonary complications in elderly lung cancer patients. ( JPRN-UMIN000003631).

Graded exercise testing and postthoracotomy complications

A controversy exists over whether or not preoperative exercise testing can predict postthoracotomy complications. This study was designed to evaluate the usefulness of a presurgical exercise protocol in patients with lung disease, but no evidence of cardiac disease. Seventy patients underwent baseline pulmonary function testing and split function perfusion studies, when indicated, to calculate predicted postoperative pulmonary function. Noninvasive data were incrementally collected from 17 patients by using a treadmill exercise tolerance test that was designed to elicit maximal performance. Inhaled and exhaled gas flow and, volume, the partial pressure of O 2 and CO 2, maximal O 2 consumption (V̇O 2max), and maximal minute ventilation (V̇ E Max) were measured. The breathing and heart rate reserves were calculated by standard formulae in an attempt to separate cardiac from pulmonary exercise limitation. Two patients had postoperative cardiopulmonary complications after thoracotomy and lung resection, and six patients had noncardiopulmonary complications. There was no significant prognostic relationship among V̇O 2 max, V̇ E max. maximum O 2 pulse, and the incidence of postoperative cardiopulmonary complications. The percentages of predicted V̇ E max and predicted maximum heart rate were related to the occurrence of total complications, but not specifically to cardiopulmonary complications. The results emphasize the difficulty in attempting to exercise thoracotomy candidates with chronic lung disease to maximal performance. Excluding patients from further surgical consideration because of exercise limitation is not feasible based on these data.