Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
BMC Anesthesiol. 2022 Apr 23;22(1):120. doi: 10.1186/s12871-022-01660-2.
To assess the prevalence of postoperative pulmonary complications (PPCs), the perioperative factors associated with PPCs, and the association of PPCs with postoperative outcomes in ovarian cancer patients undergoing cytoreductive surgery.
A retrospective analysis was conducted on patients who underwent cytoreductive surgery in our hospital, between September 2017 and January 2021, and patient medical records were reviewed to collect relevant clinical information. Univariable and multivariable analyses were used to identify significant risk factors for PPCs. Analysis of the association of PPCs with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and multivariable logistic regression model.
Final analysis was performed with 268 ovarian cancer patients after cytoreductive surgery, among whom the incidence of PPCs was 26.9%, and the most frequent pulmonary complication was pleural effusion. According to the multivariate analysis, the intraoperative fluid infusion volume (L) (odds ratio (OR) 1.34; 95% confidence intervals (CI) 1.01-1.77; P = 0.040), diameter size of diaphragmatic resection (cm) (OR 1.16; 95% CI 1.06-1.28; P = 0.002), and surgical complexity scores (OR 1.26; 95% CI 1.13-1.42; P < 0.001) were significantly associated with the development of PPCs. The multivariable logistic regression analyses with propensity-matched controls demonstrated that the occurrence of PPCs significantly increased the risk of 30-day readmission (OR 6.01; 95% CI 1.12-32.40; P = 0.037) and did not significantly affect inpatient mortality.
Ovarian cancer patients undergoing cytoreductive surgery, especially those with diaphragmatic resection or higher surgical complexity scores, represent a high-risk population for PPCs. In addition, goal-directed fluid therapy is vital to reducing the occurrence of PPCs in patients at risk. PPCs were not associated with in-hospital mortality but were significantly associated with an increased risk of 30-day readmission after cytoreductive surgery.
评估卵巢癌患者行细胞减灭术后肺部并发症（PPCs）的发生率，分析与 PPCs 相关的围手术期因素，以及 PPCs 与术后结局的关系。
回顾性分析 2017 年 9 月至 2021 年 1 月在我院行细胞减灭术的患者的病历资料，收集相关临床信息。采用单因素和多因素分析方法确定 PPCs 的显著危险因素。采用倾向性评分匹配对照和多因素逻辑回归模型分析 PPCs 与术后结局（死亡率和 30 天再入院率）的关系。
最终对 268 例行细胞减灭术的卵巢癌患者进行了分析，其中 PPCs 的发生率为 26.9%，最常见的肺部并发症是胸腔积液。多因素分析显示，术中液体输注量（L）（比值比（OR）1.34；95%置信区间（CI）1.01-1.77；P=0.040）、膈肌切除直径（cm）（OR 1.16；95%CI 1.06-1.28；P=0.002）和手术复杂程度评分（OR 1.26；95%CI 1.13-1.42；P<0.001）与 PPCs 的发生显著相关。采用倾向性评分匹配对照的多因素逻辑回归分析表明，PPCs 的发生显著增加了 30 天再入院的风险（OR 6.01；95%CI 1.12-32.40；P=0.037），但对住院死亡率无显著影响。
行细胞减灭术的卵巢癌患者，尤其是行膈肌切除术或手术复杂程度评分较高的患者，是 PPCs 的高危人群。此外，目标导向的液体治疗对降低高危患者 PPCs 的发生至关重要。PPCs 与住院死亡率无关，但与细胞减灭术后 30 天再入院风险显著相关。
