Postoperative Remote Lung Injury and Its Impact on Surgical Outcome

Lin Chen; Hailin Zhao; Azeem Alam; Emma Mi; Shiori Eguchi; Shanglong Yao; Daqing Ma


BMC Anesthesiol. 2019;19(30) 

In This Article

Surgical Outcome of Patients With Postoperative Remote Lung Injury

Overall surgical outcome for patients who have developed lung injury after surgery is not optimistic. Kinugasa et al.[54] demonstrated that postoperative pulmonary complications (PPC) are directly related to an increase in inpatient deaths within ninety days after oesophagectomy. Patients who developed postoperative pneumonia also had a lower five-year overall survival rate compared to those without (26.7% VS 53.4%, hazard ratio = 5.380). Furthermore, pneumonia is one of two independent risk factors to predict poor long-term survival, whilst the other being pathological tumor stage. Another study conducted by Khuri et al.[55] showed that occurrence of pulmonary complications within the first thirty days after major surgery resulted in lower survival rate during the eight-year follow up period.

In a retrospective single centre study conducted in Japan, 502 patients underwent oesophageal carcinoma resection were enrolled and their postoperative complications were analysed.[56] The overall incidence of postoperative complications was 43% with the incidence of PPC was 19.7%. Importantly, patients who developed PPC experienced a decreased overall survival rate with a multivariable hazard ratio of 1.60.

Recently, a meta-analysis discussed the relationship between postoperative lung injury and the incidence of mortality and mobility after abdominal or thoracic surgery.[9] Among 3365 patients, the overall incidence of postoperative lung injury was approximately 4% regardless of types of surgery; however, postoperative lung injury after thoracic surgery was associated with higher patient morbidity. It was found that lung protective ventilation during surgery resulted in a lower incidence of postoperative lung injury, although it has no effect on postoperative mortality. In addition, patients with postoperative lung injury or PPC required longer mechanical ventilation support as well as longer ICU and hospital stay, which contributed towards a higher financial burden on healthcare system.[9,57,58]