McDowell Brittany J, Karamchandani Kunal, Lehman Erik B, Conboy Matthew J, Carr Zyad J
Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Penn State University College of Medicine, Hershey, PA, USA.
Can J Anaesth. 2021 Jan;68(1):81-91. doi: 10.1007/s12630-020-01828-9. Epub 2020 Oct 8.
Perioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients.
We performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adjust for multiple interactions, the false discovery rate (Q value) was utilized to appropriately adjust P values and a Q value < 0.05 was considered to be significant.
Two hundred and eighty-two patients were identified. After excluding emergency cases and bronchoscopies performed for active pneumonia, 14.2% of the cohort developed ARW that persisted > 24 hr after surgery, 5.0% had AE-IPF, and 9.2% were diagnosed with postoperative pneumonia within 30 days of surgery. The 30-day mortality was 6.0% and the one-year mortality was 14.9%. Preoperative home oxygen use (relative risk [RR], 2.70; 95% confidence interval [CI], 1.50 to 4.86; P < 0.001) and increasing surgical time (per 60 min) (RR, 1.03; 95% CI, 1.02 to 1.05; P < 0.001) were identified as independent risk factors for postoperative ARW.
In IPF patients, preoperative home oxygen requirement and increasing surgical time showed a strong relationship with postoperative ARW and may be useful markers for perioperative risk stratification. Facteurs de risque périopératoires des patients atteints de fibrose pulmonaire idiopathique : une étude de cohorte historique.
特发性肺纤维化（IPF）患者围手术期并发症的情况尚未得到充分描述。本研究的目的是确定与IPF患者术后不良结局相关的危险因素。
我们对2008年至2018年间接受手术的成年IPF患者进行了一项单中心历史队列研究。我们使用单变量和多变量回归分析，分析了选定围手术期因素对IPF术后急性加重（AE-IPF）、急性呼吸恶化（ARW）、肺炎以及30天和1年死亡率的预后效用。为了调整多重相互作用，采用错误发现率（Q值）来适当调整P值，Q值<0.05被认为具有统计学意义。
共纳入282例患者。排除急诊病例和因活动性肺炎进行的支气管镜检查后，14.2%的队列患者术后发生持续>24小时的ARW，5.0%发生AE-IPF，9.2%在术后30天内被诊断为术后肺炎。30天死亡率为6.0%，1年死亡率为14.9%。术前家庭氧疗（相对风险[RR]，2.70；95%置信区间[CI]，1.50至4.86；P<0.001）和手术时间延长（每60分钟）（RR，1.03；95%CI，1.02至1.05；P<0.001）被确定为术后ARW的独立危险因素。
在IPF患者中，术前家庭氧需求和手术时间延长与术后ARW密切相关，可能是围手术期风险分层的有用指标。特发性肺纤维化患者的围手术期危险因素：一项历史队列研究。
