Risk Factors for Acute Lung Injury After Thoracic Surgery for Lung Cancer

TLDR

Acute lung injury is a significant postoperative complication of thoracic surgery that contributes substantially to mortality. The study aimed to identify risk factors for ALI in 879 consecutive patients undergoing pulmonary resection for non‑small cell lung carcinoma. Researchers prospectively collected clinical, anesthetic, surgical, radiological, biochemical, and histopathologic data from these patients. ALI occurred in 4.2% of cases, with a delayed‑onset form triggered by intercurrent complications (60% mortality) and an early primary form (26% mortality) associated with high intraoperative pressure index, excess fluid, pneumonectomy, and preoperative alcohol abuse.

Abstract

In Brief Acute lung injury (ALI) may complicate thoracic surgery and is a major contributor to postoperative mortality. We analyzed risk factors for ALI in a cohort of 879 consecutive patients who underwent pulmonary resections for non-small cell lung carcinoma. Clinical, anesthetic, surgical, radiological, biochemical, and histopathologic data were prospectively collected. The total incidence of ALI was 4.2% (n = 37). In 10 cases, intercurrent complications (bronchopneumonia, n = 5; bronchopulmonary fistula, n = 2; gastric aspiration, n = 2; thromboembolism, n = 1) triggered the onset of ALI 3 to 12 days after surgery, and this was associated with a 60% mortality rate (secondary ALI). In the remaining 27 patients, no clinical adverse event preceded the development of ALI—0 to 3 days after surgery—that was associated with a 26% mortality rate (primary ALI). Four independent risk factors for primary ALI were identified: high intraoperative ventilatory pressure index (odds ratio, 3.5; 95% confidence interval, 1.7–8.4), excessive fluid infusion (odds ratio, 2.9; 95% confidence interval, 1.9–7.4), pneumonectomy (odds ratio, 2.8; 95% confidence interval, 1.4–6.3), and preoperative alcohol abuse (odds ratio, 1.9; 95% confidence interval, 1.1–4.6). In conclusion, we describe two clinical forms of postthoracotomy ALI: 1) delayed-onset ALI triggered by intercurrent complications and 2) an early form of ALI amenable to risk-reducing strategies, including preoperative alcohol abstinence, lung-protective ventilatory modes, and limited fluid intake. IMPLICATIONS: In an observational study including all patients undergoing lung surgery, we describe two clinical forms of acute lung injury (ALI): a delayed-onset form triggered by intercurrent complications and an early form associated with preoperative alcohol consumption, pneumonectomy, high intraoperative pressure index, and excessive fluid intake over the first 24 h.