Brittany J McDowell1,2, Kunal Karamchandani1,2, Erik B Lehman3, Matthew J Conboy2, Zyad J Carr4,5. 1. Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA. 2. Penn State University College of Medicine, Hershey, PA, USA. 3. Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA. 4. Department of Anesthesiology, Yale New Haven Hospital, 20 York St., New Haven, CT, 06510, USA. zyad.carr@yale.edu. 5. Yale School of Medicine, New Haven, CT, USA. zyad.carr@yale.edu.
Abstract
PURPOSE: Perioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients. METHODS: We performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adjust for multiple interactions, the false discovery rate (Q value) was utilized to appropriately adjust P values and a Q value < 0.05 was considered to be significant. RESULTS: Two hundred and eighty-two patients were identified. After excluding emergency cases and bronchoscopies performed for active pneumonia, 14.2% of the cohort developed ARW that persisted > 24 hr after surgery, 5.0% had AE-IPF, and 9.2% were diagnosed with postoperative pneumonia within 30 days of surgery. The 30-day mortality was 6.0% and the one-year mortality was 14.9%. Preoperative home oxygen use (relative risk [RR], 2.70; 95% confidence interval [CI], 1.50 to 4.86; P < 0.001) and increasing surgical time (per 60 min) (RR, 1.03; 95% CI, 1.02 to 1.05; P < 0.001) were identified as independent risk factors for postoperative ARW. CONCLUSIONS: In IPF patients, preoperative home oxygen requirement and increasing surgical time showed a strong relationship with postoperative ARW and may be useful markers for perioperative risk stratification. Facteurs de risque périopératoires des patients atteints de fibrose pulmonaire idiopathique : une étude de cohorte historique.
PURPOSE: Perioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients. METHODS: We performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adjust for multiple interactions, the false discovery rate (Q value) was utilized to appropriately adjust P values and a Q value < 0.05 was considered to be significant. RESULTS: Two hundred and eighty-two patients were identified. After excluding emergency cases and bronchoscopies performed for active pneumonia, 14.2% of the cohort developed ARW that persisted > 24 hr after surgery, 5.0% had AE-IPF, and 9.2% were diagnosed with postoperative pneumonia within 30 days of surgery. The 30-day mortality was 6.0% and the one-year mortality was 14.9%. Preoperative home oxygen use (relative risk [RR], 2.70; 95% confidence interval [CI], 1.50 to 4.86; P < 0.001) and increasing surgical time (per 60 min) (RR, 1.03; 95% CI, 1.02 to 1.05; P < 0.001) were identified as independent risk factors for postoperative ARW. CONCLUSIONS: In IPF patients, preoperative home oxygen requirement and increasing surgical time showed a strong relationship with postoperative ARW and may be useful markers for perioperative risk stratification. Facteurs de risque périopératoires des patients atteints de fibrose pulmonaire idiopathique : une étude de cohorte historique.
Authors: Morad Chughtai; Chukwuweike U Gwam; Anton Khlopas; Jared M Newman; Gannon L Curtis; Pedro A Torres; Rafay Khan; Michael A Mont Journal: Surg Technol Int Date: 2017-07-25
Authors: Dina Visca; Vicky Tsipouri; Letizia Mori; Ashi Firouzi; Sharon Fleming; Morag Farquhar; Elizabeth Leung; Toby M Maher; Paul Cullinan; Nick Hopkinson; Athol U Wells; Winston Banya; Jennifer A Whitty; Huzaifa Adamali; Lisa G Spencer; Piersante Sestini; Elisabetta A Renzoni Journal: Trials Date: 2017-04-28 Impact factor: 2.279