Agostini Paula J, Lugg Sebastian T, Adams Kerry, Smith Tom, Kalkat Maninder S, Rajesh Pala B, Steyn Richard S, Naidu Babu, Rushton Alison, Bishay Ehab
Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
J Cardiothorac Surg. 2018 Apr 12;13(1):28. doi: 10.1186/s13019-018-0717-6.
Postoperative pulmonary complications (PPCs) are associated with poor outcomes following thoracotomy and lung resection. Video-assisted thoracoscopic surgery (VATS) for lobectomy is now frequently utilised as an alternative to thoracotomy, however patients remain at risk for development of PPC. There is little known of the short-term outcome associated with PPC following VATS lobectomy and if there are any potential risk factors that could be modified to prevent PPC development; our study aimed to investigate this.
A prospective observational study of consecutive patients undergoing VATS lobectomy for lung cancer over a 4-year period in a regional centre was performed (2012-2016). Exclusion criteria included re-do VATS or surgery for pulmonary infection. All patients received physiotherapy as necessary from postoperative day 1 (POD1) and PPC was determined using the Melbourne Group Scale. Outcomes included hospital LOS, intensive therapy unit (ITU) admission and hospital mortality.
Of the 285 patients included in the study, 137 were male (48.1%), the median (IQR) age was 69 (13) years and the mean (±SD) FEV% predicted was 87% (±19). Patients that developed a PPC (n = 21; 7.4%) had a significantly longer hospital LOS (4 vs. 3 days), higher frequency of ITU admission (23.8% vs. 0.5%) and higher hospital mortality (14.3% vs. 0%) (p < 0.001). PPC patients also required more physiotherapy contacts/time, emergency call-outs and specific pulmonary therapy (p < 0.05). Current smoking and COPD diagnosis were significantly associated with development of PPC on univariate analysis (p < 0.05), however only current smoking was a significant independent risk factor on multivariate analysis (p = 0.015).
Patients undergoing VATS lobectomy remain at risk of developing a PPC, which is associated with an increase in physiotherapy requirements and a worse short-term morbidity and mortality. Current smoking is the only independent risk factor for PPC after VATS lobectomy, thus vigorous addressing of preoperative smoking cessation is urgently needed.
术后肺部并发症（PPCs）与开胸手术和肺切除术后的不良预后相关。电视辅助胸腔镜手术（VATS）肺叶切除术目前常被用作开胸手术的替代方法，然而患者仍有发生PPC的风险。关于VATS肺叶切除术后PPC相关的短期预后以及是否存在任何可改变以预防PPC发生的潜在危险因素，目前知之甚少；我们的研究旨在对此进行调查。
对一个地区中心在4年期间（2012 - 2016年）连续接受VATS肺癌肺叶切除术的患者进行前瞻性观察研究。排除标准包括再次VATS手术或肺部感染手术。所有患者从术后第1天（POD1）起根据需要接受物理治疗，并使用墨尔本小组量表确定PPC。结局指标包括住院时间、重症监护病房（ITU）入住情况和医院死亡率。
纳入研究的285例患者中，137例为男性（48.1%），中位（IQR）年龄为69（13）岁，预计FEV%均值（±标准差）为87%（±19）。发生PPC的患者（n = 21；7.4%）住院时间显著更长（4天对3天），ITU入住频率更高（23.8%对0.5%），医院死亡率更高（14.3%对0%）（p < 0.001）。PPC患者还需要更多的物理治疗接触/时间、紧急出诊和特定的肺部治疗（p < 0.05）。单因素分析显示，当前吸烟和慢性阻塞性肺疾病（COPD）诊断与PPC的发生显著相关（p < 0.05），然而多因素分析中只有当前吸烟是显著的独立危险因素（p = 0.015）。
接受VATS肺叶切除术的患者仍有发生PPC的风险，这与物理治疗需求增加以及短期发病率和死亡率恶化相关。当前吸烟是VATS肺叶切除术后PPC的唯一独立危险因素，因此迫切需要大力解决术前戒烟问题。
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