BACKGROUND

Pulmonary resection for pulmonary nodules has raised concerns about perioperative complications. Postoperative cough after pulmonary resection (CAP) is a frequent and debilitating issue in non-small cell lung cancer (NSCLC) patients, yet its risk factors remain unclear. Therefore, the aim of this study was to use evidence-based medicine evidence to find the key risk factors associated with CAP in the hope of improving the prognosis of patients undergoing pulmonary resection.

METHODS

A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines. A comprehensive search of PubMed, Embase, and the Cochrane Library up to October 1, 2024, identified studies on CAP risk factors. Data on demographics, surgical factors, and postoperative outcomes were extracted and synthesized using a random-effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated, and sensitivity analyses were performed. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included cohort studies, the Cochrane Risk of Bias Tool was used to assess the risk of bias in randomized controlled trials (RCTs), and Egger's test was used to detect any probable publication bias.

RESULTS

Nine studies involving 2,751 patients were included. Most of these patients were from China, with a small number coming from Japan. A total of 826 patients included developed CAP. Key risk factors for CAP included surgical factors such as right-sided lung surgery (OR =1.55; 95% CI: 1.14-2.12; P=0.006), lobectomy (OR =2.27; 95% CI: 1.62-3.19; P<0.001), and mediastinal lymph node dissection (OR =3.87; 95% CI: 2.17-6.88; P<0.001). Longer surgery (MD =16.17; 95% CI: 3.07-29.26; P=0.02) and anesthesia durations (MD =19.94; 95% CI: 12.76-27.13; P<0.001), and postoperative gastroesophageal reflux disease (GERD) (OR =4.96; 95% CI: 2.05-12.02; P<0.001) were also significant contributors. Sensitivity analysis confirmed the stability of the findings.

CONCLUSIONS

This meta-analysis emphasizes the role of surgical and perioperative factors in the development of CAP, highlighting the need for careful surgical planning and management to improve postoperative outcomes.