Dai Yuanqiang, Sun Guolin, Hu Hongli, Wang Chun, Wang Hengyue, Zha Yanping, Sheng Ying, Hou Jiong, Bian Jinjun, Bo Lulong
Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China.
Front Oncol. 2022 Sep 20;12:1002025. doi: 10.3389/fonc.2022.1002025. eCollection 2022.
Postoperative pulmonary complications (PPCs) are common and associated with adverse outcomes impairing long-term survival and quality of recovery. This single-centered retrospective study aimed to examine factors associated with PPCs in patients receiving elective colorectal surgery aged ≥60 years.
Between January 2019 and December 2019, 638 patients at the Shanghai Changhai Hospital who had received elective surgery for colorectal cancer were enrolled in this study. Patients were divided into the PPC group (n=38) and non-PPC group (n=600). Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red blood cell distribution width (RDW), and systemic inflammatory index (SII) were selected and caculated to indicate preoperative and postoperative inflammatory status. Receiver operating characteristic curve and bivariate correlation analyses were performed to evaluate the identified risk factors.
The overall incidence of PPCs was approximately 5.96%. Multivariate regression analysis identified age (OR = 1.094, 95%CI 1.038-1.153, = 0.001), preoperative RDW (OR = 1.159, 95%CI 1.025-1.309, = 0.018), and preoperative SII (OR = 1.001, 95%CI 1.000-1.003, = 0.035) as independent risk factors for PPCs. The cut-off values of age, preoperative RDW, and preoperative SII for predicting PPCs were 69.5 (sensitivity 0.658, specificity 0.653), 13.2 (sensitivity 0.789, specificity 0.552) and 556.1 (sensitivity 0.579, specificity 0.672), respectively.
Age, preoperative RDW, and preoperative SII were identified as independent risk factors for PPC occurrence in elderly patients receiving elective colorectal surgery. Further studies are warranted to evaluate whether normalization of preoperative RDW and SII, as modifiable risk factors, are associated with improved surgical outcomes.
术后肺部并发症（PPCs）很常见，且与不良预后相关，会影响长期生存和恢复质量。这项单中心回顾性研究旨在探讨年龄≥60岁的择期结直肠手术患者中与PPCs相关的因素。
2019年1月至2019年12月期间，上海长海医院638例接受择期结直肠癌手术的患者纳入本研究。患者分为PPC组（n = 38）和非PPC组（n = 600）。选择并计算中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、红细胞分布宽度（RDW）和全身炎症指数（SII），以表明术前和术后的炎症状态。进行受试者工作特征曲线和双变量相关性分析，以评估所确定的危险因素。
PPCs的总体发生率约为5.96%。多因素回归分析确定年龄（OR = 1.094，95%CI 1.038 - 1.153，P = 0.001）、术前RDW（OR = 1.159，95%CI 1.025 - 1.309，P = 0.018）和术前SII（OR = 1.001，95%CI 1.000 - 1.003，P = 0.035）为PPCs的独立危险因素。年龄、术前RDW和术前SII预测PPCs的截断值分别为69.5（敏感性0.658，特异性0.653）、13.2（敏感性0.789，特异性0.552）和556.1（敏感性0.579，特异性0.672）。
年龄、术前RDW和术前SII被确定为接受择期结直肠手术的老年患者发生PPCs的独立危险因素。有必要进一步研究评估术前RDW和SII作为可改变的危险因素实现正常化是否与改善手术结局相关。
