Gómez-Hernández María Teresa, Rivas Cristina, Novoa Nuria, Jiménez Marcelo F
Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
Salamanca Institute of Biomedical Research, Salamanca, Spain.
Front Surg. 2023 Feb 21;10:1077046. doi: 10.3389/fsurg.2023.1077046. eCollection 2023.
Rescue failure has been described as an important factor that conditions postoperative mortality after surgical interventions. The objective of this study is to determine the incidence and main determinants of failure to rescue after anatomical lung resections.
Prospective multicenter study that included all patients undergoing anatomical pulmonary resection between December 2016 and March 2018 and registered in the Spanish nationwide database GEVATS. Postoperative complications were classified as minor (grades I and II) and major (grades IIIa to V) according to the Clavien-Dindo standardized classification. Patients that died after a major complication were considered rescue failure. A stepwise logistic regression model was created to identify predictors of failure to rescue.
3,533 patients were analyzed. In total, 361 cases (10.2%) had major complications, of which 59 (16.3%) could not be rescued. The variables associated with rescue failure were: ppoDLCO% (OR, 0.98; 95% CI, 0.96-1; = 0.067), cardiac comorbidity (OR, 2.1; 95% CI, 1.1-4; = 0.024), extended resection (OR, 2.26; 95% CI, 0.94-5.41; = 0.067), pneumonectomy (OR, 2.53; 95 CI, 1.07-6.03; = 0.036) and hospital volume <120 cases per year (OR, 2.53; CI 95%, 1.26-5.07; = 0.009). The area under the curve of the ROC curve was 0.72 (95% CI: 0.64-0.79).
A significant percentage of patients who presented major complications after anatomical lung resection did not survive to discharge. Pneumonectomy and annual surgical volume are the risk factors most closely related to rescue failure. Complex thoracic surgical pathology should be concentrated in high-volume centers to obtain the best results in potentially high-risk patients.
救援失败被认为是影响手术干预后术后死亡率的一个重要因素。本研究的目的是确定解剖性肺切除术后救援失败的发生率及主要决定因素。
一项前瞻性多中心研究，纳入了2016年12月至2018年3月期间在西班牙全国性数据库GEVATS中登记的所有接受解剖性肺切除术的患者。根据Clavien-Dindo标准化分类，术后并发症分为轻微（I级和II级）和严重（IIIa至V级）。发生严重并发症后死亡的患者被视为救援失败。建立逐步逻辑回归模型以识别救援失败的预测因素。
分析了3533例患者。共有361例（10.2%）发生严重并发症，其中59例（16.3%）救援失败。与救援失败相关的变量有：术后第1秒用力呼气容积占预计值百分比（OR，0.98；95%CI，0.96 - 1；P = 0.067）、心脏合并症（OR，2.1；95%CI，1.1 - 4；P = 0.024）、扩大切除术（OR，2.26；95%CI，0.94 - 5.41；P = 0.067）、肺切除术（OR，2.53；95%CI，1.07 - 6.03；P = 0.036）以及每年手术量<120例（OR，2.53；95%CI，1.26 - 5.07；P = 0.009）。ROC曲线下面积为0.72（95%CI：0.64 - 0.79）。
解剖性肺切除术后出现严重并发症的患者中有相当比例未能存活至出院。肺切除术和年度手术量是与救援失败关系最密切的危险因素。复杂的胸外科病理手术应集中在手术量大的中心，以便在潜在高危患者中取得最佳效果。
