Evaluation of Risk Factors for Cardiac Complications After Lung Resection

Yıl 2022, Cilt: 5 Sayı: 1, 43 - 53, 30.04.2022

Yücel Özgür Zeynep Nilgün Ulukol

Öz

Abstract
Background:The aim of this study was to investigate cardiac complications in patients following lung resections performed in our hospital. The perioperative data of 1186 patients who underwent lung resection between 2017 and 2020 were evaluated retrospectively. Cardiac complications occurred in 136 patients. The relationship between these complications and the patients’ perioperative characteristics was analyzed.
Results:There were 287 (81.8%) men and 64 (18.2%) women. The mean age was 58.9 years. Postoperative cardiac complications were significantly more frequent among patients who were older than 65 years (p = 0.001) and male (p = 0.02); had congestive heart failure (CHF) (p < 0.001), coronary artery disease (CAD) (p = 0.003), hypertension (HT) (p = 0.002), hyperlipidemia (HL) (p < 0.001), chronic obstructive pulmonary disease (COPD) (p < 0.001), thyroid disease (p = 0.003), chronic renal failure (CRF) (p = 0.03), cerebrovascular accident (CVA) (p <0.001), or arrhythmia (p < 0.001); underwent surgery due to lung cancer (p = 0.008); received neoadjuvant therapy (p < 0.001); and had ejection fraction (EF) < 60% (p < 0.001). Surgical factors associated with higher rate of PCC were undergoing pneumonectomy (p < 0.001), thoracotomy (p = 0.02), and receiving intraoperative blood transfusion (p < 0.001) or inotropes (p < 0.001). Multiple logistic regression analysis showed that preoperative thyroid disease (p = 0.04), CVA (p = 0.0001), neoadjuvant therapy (p = 0.002), EF < 60% (p = 0.01), pneumonectomy (p = 0.003), intraoperative blood transfusion (p < 0.0001), and high SOFA score (p < 0.0001) were independent risk factors affecting PCC development.
Conclusion:Cardiac complications after lung resection were strongly associated with male sex, HT, pneumonectomy, thoracotomy, inotrope use, and neoadjuvant therapy.

Keywords: Lung resection, Cardiac complications, Atrial fibrillation, Thoracotomy, Video-assisted thoracoscopic surgery

Anahtar Kelimeler

lung resection, Cardiac complication, VATS, Thoracotomy

Akciğer Rezeksiyonu Sonrasi Gelişen Kardiyak Komplikasyonlar İçin Risk Faktörlerinin Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı hastanemizde yapılan akciğer rezeksiyonları sonrası hastalarda görülen kardiyak komplikasyonları(KK) araştırmaktır. 2017-2020 yılları arasında akciğer rezeksiyonu yapılan 1186 hastanın perioperatif verileri retrospektif olarak değerlendirildi. 136 hastada kardiyak komplikasyon gelişti. Bu komplikasyonlar ile hastaların perioperatif özellikleri arasındaki ilişki analiz edildi.
Bulgular: 287 (%81.8) erkek ve 64 (%18.2) kadın vardı. Ortalama yaş 58.9 idi. Ameliyat sonrası kardiyak komplikasyonlar 65 yaş üstü (p = 0,001) ve erkek (p = 0,02) olan hastalarda anlamlı olarak daha sıktı; konjestif kalp yetmezliği (KKY) (p < 0,001), koroner arter hastalığı (KAH) (p = 0,003), hipertansiyon (HT) (p = 0,002), hiperlipidemi (HL) (p < 0,001), kronik obstrüktif akciğer hastalığı ( KOAH) (p < 0,001), tiroid hastalığı (p = 0,003), kronik böbrek yetmezliği (KBY) (p = 0,03), serebrovasküler olay (SVO) (p <0,001) veya aritmi (p < 0,001); akciğer kanseri nedeniyle ameliyat oldu (p = 0,008); neoadjuvan tedavi aldı (p < 0,001); ve ejeksiyon fraksiyonu (EF) < %60 (p < 0.001) vardı. Daha yüksek KK oranı ile ilişkili cerrahi faktörler, pnömonektomi (p < 0.001), torakotomi (p = 0.02) ve intraoperatif kan transfüzyonu (p < 0.001) veya inotrop (p < 0.001) almaktı. Çoklu lojistik regresyon analizi, ameliyat öncesi tiroid hastalığı (p = 0.04), CVA (p = 0.0001), neoadjuvan tedavi (p = 0.002), EF < %60 (p = 0.01), pnömonektomi (p = 0.003), intraoperatif kan transfüzyonu gösterdi. (p < 0.0001) ve yüksek SOFA skoru (p < 0.0001) PCC gelişimini etkileyen bağımsız risk faktörleriydi.
Sonuç: Akciğer rezeksiyonu sonrası kardiyak komplikasyonlar erkek cinsiyet, HT, pnömonektomi, torakotomi, inotrop kullanımı ve neoadjuvan tedavi ile güçlü bir şekilde ilişkiliydi.

Anahtar Kelimeler

VATS, Akciğer rezeksiyonu, Torakotomi, Kardiyak komplikasyon

Kaynakça

• 1) Stéphan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, Bonnet F. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000 ;118(5):1263-70.
• 2) De Decker K, Jorens PG, Van Schil P. Cardiac complications after noncardiac thoracic surgery: an evidence-based current review. Ann Thorac Surg. 2003 Apr;75(4):1340-8.
• 3) Rena O, Papalia E, Oliaro A, Casadio C, Ruffini E, Filosso PL, Sacerdote C, Maggi G. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg. 2001 Oct;20(4):688-93.
• 4) Algar FJ, Alvarez A, Salvatierra A, Baamonde C, Aranda JL, López-Pujol FJ. Predicting pulmonary complications after pneumonectomy for lung cancer. Eur J Cardiothorac Surg. 2003 Feb;23(2):201-8.
• 5) Fu D, Wu C, Li X, Chen J. Elevated preoperative heart rate associated with increased risk of cardiopulmonary complications after resection for lung cancer. BMC Anesthesiol 2018 Jul 25;18(1):94.
• 6) Erol Y, Ergönül AG, Özdil A, Nalbantgil S, Çağırıcı U, Turhan K, Çakan A. Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection. Heart Lung Circ. 2019 Jul;28(7):1099-1101.
• 7) Dominguez-Ventura A, Allen MS, Cassivi SD, Nichols FC 3rd, Deschamps C, Pairolero PC. Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection. Ann Thorac Surg. 2006 Oct;82(4):1175-9.
• 8) Smilowitz NR, Berger JS. Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery: A Review. JAMA. 2020;324(3):279–290.
• 9) Fernandes EO, Teixeira C, Silva LC. Thoracic surgery: risk factors for postoperative complications of lung resection. Rev Assoc Med Bras (1992). 2011 May-Jun;57(3):292-8.
• 10) Sandri A, Petersen RH, Decaluwé H, Moons J, Ferguson MK, Hansen HJ, Brunelli A. Coronary artery disease is associated with an increased mortality rate following video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg. 2017 Jul;154(1):352-357.
• 11) Duc Ha, Humberto Choi, Katrina Zell et Al. Association Of İmpaired Heart Rate Recovery With Cardiopulmonary Complications After Lung Cancer Resection Surgery. J Thorac Cardiovasc Surg 2015;149:1168-73.
• 12) Cardinale D, Martinoni A, Cipolla CM, Civelli M, Lamantia G, Fiorentini C, Mezzetti M. Atrial fibrillation after operation for lung cancer: clinical and prognostic significance. Ann Thorac Surg. 1999 Nov;68(5):1827-31.
• 13) Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study. J Cardiothorac Surg. 2012 Jan 10;7:4.
• 14) Ivanovic J, Maziak DE, Ramzan S, McGuire AL, Villeneuve PJ, Gilbert S, Sundaresan RS, Shamji FM, Seely AJ. Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection. Interact Cardiovasc Thorac Surg. 2014 Mar;18(3):340-6.
• 15) Agostini PJ, Lugg ST, Adams K, Smith T, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg 2018 Apr 12;13(1):28.
• 16) Pedoto A., Amar D. Perioperative Arrhythmias and Acute Right Heart Failure in Noncardiac Thoracic Surgery. Curr Anesthesiol Rep 2014; 4:142–149.
• 17) Vretzakis G, Simeoforidou M, Stamoulis K, Bareka M. Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance? Anesthesiol Res Pract. 2013;2013:413985. doi: 10.1155/2013/413985.
• 18) Figas-Powajbo E, Gawor Z, Kozak J. Perioperative cardiac arrhythmias in patients undergoing surgical treatment for lung cancer. Pol Arch Med Wewn. 2007 Jul;117(7):290-6.
• 19) Tisdale Je, Wroblewski Ha, Wall Ds,A Randomized Trial Evaluating Amiodarone For Prevention Of Atrial Fibrillation After Pulmonary Resection. Ann Thorac Surg 2009;88(3):886-93.