Saetang Mantana, Kunapaisal Thitikan, Wasinwong Wirat, Boonthum Parin, Sriyanaluk Bussarin, Nuanjun Kanjana
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
Division of CardioVascular Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
PLoS One. 2024 Dec 31;19(12):e0316214. doi: 10.1371/journal.pone.0316214. eCollection 2024.
To highlight the risk assessment tool associated with postoperative cardiopulmonary complications of Clavien-Dindo (CD) ≥ II in elderly patients who underwent lung cancer surgery.
In patients ≥ 60 years admitted during 2020-2023 and having undergone lung cancer surgery, postoperative cardiopulmonary complications were examined using the CD classification as groups (CD grade I versus ≥ II), and the risk factors were analyzed using logistic regression and receiver operating characteristic (ROC) curves.
Of the 239 elderly patients, 29.3% had postoperative complications (CD ≥ II). Subgroup analysis revealed that patients aged ≥70 years had a higher rate of postoperative complications compared to those aged 60-69 years, however, this relationship was not statistically significant in the multivariable model (OR: 2.03, 95% CI: 0.95-4.36, p = 0.068). The CD grade ≥ II group had longer surgical time (p = 0.002), greater postoperative pulmonary complications (p < 0.001), and longer length of hospital stay (p < 0.001); CD grade ≥ II was more likely in patients with older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.02-1.15, p = 0.011), COPD (OR: 4.41, 95% CI: 1.55-13.44, p = 0.005) and smoking history (OR: 2.85, 95% CI: 1.12-7.24, p = 0.028), having undergone pneumonectomy (OR: 14.89, 95% CI: 1.71-334.9, p = 0.045), and who converted to open thoracotomy (OR: 16.33, 95% CI: 2.13-169.71, p = 0.007). The area under the ROC curve was 0.81.
Older age (≥70 years) is associated with higher rates of postoperative complications (CD classification ≥ II) but is not an independent predictor when adjusting for other factors. Comorbidities such as COPD and surgical factors, including pneumonectomy and conversion to thoracotomy, are significant contributors. These findings emphasize the need for comprehensive, multifactorial risk assessments to guide perioperative management and improve outcomes in elderly lung cancer patients.
强调与老年肺癌手术患者中Clavien-Dindo（CD）≥II级术后心肺并发症相关的风险评估工具。
对2020 - 2023年期间收治的≥60岁且接受过肺癌手术的患者，使用CD分类将术后心肺并发症分为不同组（CD I级与≥II级），并采用逻辑回归和受试者工作特征（ROC）曲线分析危险因素。
239例老年患者中，29.3%有术后并发症（CD≥II）。亚组分析显示，≥70岁患者的术后并发症发生率高于60 - 69岁患者，然而，在多变量模型中这种关系无统计学意义（比值比[OR]：2.03，95%置信区间[CI]：0.95 - 4.36，p = = 0.068）。CD≥II级组手术时间更长（p = 0.002），术后肺部并发症更多（p < 0.001），住院时间更长（p < 0.001）；年龄较大（OR：1.08，95%置信区间[CI]：1.02 - 1.15，p = 0.011）、慢性阻塞性肺疾病（COPD，OR：4.41，95% CI：1.55 - 13.44，p = 0.005）、有吸烟史（OR：2.85，95% CI：1.12 - 7.24，p = 0.028）、接受过肺切除术（OR：14.98，95% CI：1.71 - 334.9，p = 0.045）以及转为开胸手术（OR：16.33，95% CI：2.13 - 169.71，p = 0.007）的患者更易发生CD≥II级情况。ROC曲线下面积为0.81。
年龄较大（≥70岁）与术后并发症发生率较高（CD分类≥II）相关，但在调整其他因素后不是独立预测因素。COPD等合并症以及包括肺切除术和转为开胸手术在内的手术因素是重要影响因素。这些发现强调需要进行全面的多因素风险评估，以指导围手术期管理并改善老年肺癌患者的预后。
