右全肺切除术后，因心肺原因导致的死亡风险随时间的推移而增加：倾向评分匹配分析。
The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis.
机构信息
Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
出版信息
Eur J Cardiothorac Surg. 2013 Jul;44(1):93-7. doi: 10.1093/ejcts/ezs620. Epub 2012 Dec 11.
OBJECTIVES
The study aimed to compare in-hospital, 30-day and non-cancer-related 6-month death rates in a series of right and left pneumonectomy cases matched according to functional parameters.
METHODS
A retrospective study was conducted on a series of 263 non-small cell lung cancer patients who underwent pneumonectomy. Left and right pneumonectomy cases were matched according to propensity scores using the following variables: age, coronary artery disease, any other cardiac comorbidity and predicted postoperative forced expiratory volume in the 1st second (ppoFEV1). After matching, 89 pairs of cases were selected. In-hospital, 30-day and 6-month crude and risk-adjusted death rates not related to cancer relapse or distant metastases were calculated for right and left pneumonectomy and compared on 2-by-2 tables using odds ratios. Death hazards were estimated by Cox regression, introducing the following independent variables in the model: age, cardiac comorbidity, ppoFEV1 and occurrence of any postoperative cardiorespiratory complication or bronchial fistula.
RESULTS
Non-cancer-related in-hospital, 30-day and 6-month death rates were, respectively, 8.4 (3.4 in left and 13.5 in right cases; P = 0.015), 11.8 (7.8 in left and 15.7 in right cases; P = 0.10) and 18.5% (12.4 in left and 24.7 in right cases; P = 0.033). On Cox regression, age, right pneumonectomy and the occurrence of postoperative cardiorespiratory complications (but not bronchial fistula) were related to the risk of death at 6 months.
CONCLUSIONS
The risk of death after pneumonectomy increases with time and strongly depends on the side of the operation (it is higher after right pneumonectomy) and on the occurrence of any postoperative cardiorespiratory complication. Neither hospital nor 30-day mortality should be reported as a valid outcome after pneumonectomy since they do not represent the real risk of the operation.
目的
本研究旨在比较一系列根据功能参数匹配的右肺和左全肺切除术患者的住院期间、30 天和非癌症相关的 6 个月死亡率。
方法
对 263 例非小细胞肺癌患者进行了一项回顾性研究，这些患者均接受了全肺切除术。通过使用以下变量的倾向评分匹配，对左全肺切除术和右全肺切除术病例进行匹配：年龄、冠状动脉疾病、任何其他心脏合并症和预测术后 1 秒用力呼气量（ppoFEV1）。匹配后，选择了 89 对病例。计算右全肺切除术和左全肺切除术的住院期间、30 天和非癌症相关的 6 个月粗死亡率和风险调整死亡率，并用比值比在 2×2 表中进行比较。通过 Cox 回归估计死亡风险，在模型中引入以下独立变量：年龄、心脏合并症、ppoFEV1 以及术后任何心肺并发症或支气管瘘的发生。
结果
非癌症相关的住院期间、30 天和 6 个月死亡率分别为 8.4%（左 3.4%，右 13.5%；P=0.015）、11.8%（左 7.8%，右 15.7%；P=0.10）和 18.5%（左 12.4%，右 24.7%；P=0.033）。在 Cox 回归中，年龄、右全肺切除术和术后心肺并发症的发生（但不是支气管瘘）与 6 个月时的死亡风险相关。
结论
全肺切除术后的死亡风险随时间而增加，并且强烈取决于手术侧（右全肺切除术的风险更高）和术后任何心肺并发症的发生。由于它们不能代表手术的实际风险，因此不应将住院期间或 30 天死亡率报告为全肺切除术后的有效结局。
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