Document Detail

A clinical prediction rule for pulmonary complications after thoracic surgery for primary lung cancer.
MedLine Citation:
PMID:  19861366     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery. METHODS: Using a prospective database, we performed an analysis of 956 patients who had resection for lung cancer at a single institution. PC was defined as the occurrence of any of the following: atelectasis, pneumonia, pulmonary embolism, respiratory failure, and need for supplemental oxygen at hospital discharge. RESULTS: PCs occurred in 121 of 956 patients (12.7%). Preoperative chemotherapy (odds ratio 1.64, 95% confidence interval 1.06-2.55, P = 0.02, point score 2) and a lower DLCOppo (odds ratio per each 5% decrement 1.13, 95% confidence interval 1.06-1.19, P < 0.0001, point score 1 per each 5% decrement of DLCOppo less than 100%) were independent risk factors for PCs. We defined 3 overall risk categories for PCs: low < or =10 points, 39 of 448 patients (9%); intermediate 11-13 points, 37 of 256 patients (14%); and high > or =14 points, 42 of 159 patients (26%). The median (range) length of hospital stay was significantly greater for patients who developed PCs than for those who did not: 12 (3-113) days vs 6 (2-39) days, P < 0.0001, respectively. Similarly, 30-day mortality was significantly more frequent for patients who developed PCs than for those who did not: 16 of 121 (13.2%) vs 6 of 835 (0.7%), P < 0.0001. CONCLUSIONS: These data show that PCs after thoracic surgery for lung cancer can be predicted with moderate accuracy based on DLCOppo and whether patients had chemotherapy. Forced expired volume in 1 s was not a predictor of PCs.
David Amar; Daisy Munoz; Weiji Shi; Hao Zhang; Howard T Thaler
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-27
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  110     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-05-13     Revised Date:  2010-05-28    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1343-8     Citation Subset:  AIM; IM    
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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MeSH Terms
Anaerobic Threshold
Analysis of Variance
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Carbon Monoxide / diagnostic use
Forced Expiratory Volume
Health Care Costs
Length of Stay
Lung Diseases / economics,  epidemiology,  etiology*
Lung Neoplasms / complications,  economics,  surgery*
Middle Aged
Postoperative Complications / economics,  epidemiology,  etiology*
Predictive Value of Tests
Pulmonary Diffusing Capacity
Regression Analysis
Risk Assessment
Thoracic Surgical Procedures*
Walking / physiology
Reg. No./Substance:
630-08-0/Carbon Monoxide
Comment In:
Anesth Analg. 2010 May 1;110(5):1261-3   [PMID:  20418289 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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