Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry

Objective Post-operative pulmonary complications (PPCs) represent the most frequent complications after lung surgery. The aim of this study was to identify the modifiable risk factors for PPCs after video-assisted thoracoscopic surgery (VATS) in lung cancer patients. Methods Data of this retrospective study were extracted from the German Thorax Registry, an interdisciplinary and multicenter database of the German Society of Anesthesiology and Intensive care medicine and the German Society of Thoracic Surgery. Univariate and multivariate stepwise logistic regression analysis of patient-specific and procedural risk factors for PPCs were conducted. Results We analyzed 376 patients with lung cancer who underwent VATS bilobectomy (n = 2), lobectomy (n = 258) or segmentectomy (n = 116) in 2016 and 2017. One-hundred fourteen patients (114/376; 30%) developed PPCs. Two patients died within 30 days after surgery. In the univariate analysis, patients of the PPC group showed significantly more often a body mass index (BMI) <= 19 kg/m(2); a pre-operative forced expiratory volume in 1 second (FEV1) <= 60%; a pre-operative arterial oxygen partial pressure (p(a)O(2)) <= 60 mm Hg; a higher rate of prolonged duration of surgery (>= 2 hours [h]) and a higher frequency of intraoperative blood loss >= 500 mL. The multivariate stepwise logistic regression analysis revealed 4 independent risk factors: FEV1 <= 60% (1.9[1.1-3.4] OR [95% CI], P = 0.029); p(a)O(2) <= 60 mm Hg (4.6[1.7-12.8] OR [95% CI], P = 0.003; duration of surgery >= 2 hours (2.7[1.5-4.7] OR [95% CI], P = 0.001) and intraoperative crystalloids >= 6 mL/kg/h (2.9[1.2-7.5] OR [95% CI], P = 0.023). Conclusion Intraoperative amount of crystalloid fluids should be kept below 6 mL/kg/h and duration of surgery should be below 2 hours to avoid an increased risk for PPCs.