Clinical characteristics and treatment experience of severe complications after thoracic surgery—ten-year outcome from a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Zhe , ZHANG Xin ,  XU Shun

Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang, 110001, P.R.China;

Corresponding?author：

XU Shun, Email: xushun610539@sina.com

Keywords：

Thoracic surgery; surgical procedures; postoperative complications

DOI：

10.7507/1007-4848.201812069

Video：

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Objective To discuss the clinical characteristics and the management of major complications after thoracic surgery.Methods Retrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized.Results The age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%).Conclusion Thoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.

Citation： XU Zhe, ZHANG Xin, XU Shun. Clinical characteristics and treatment experience of severe complications after thoracic surgery—ten-year outcome from a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 858-864. doi: 10.7507/1007-4848.201812069 Copy

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1. 王天佑. 我國胸外科發展趨勢與分會的任務. 中國肺癌雜志, 2014, 17(7): 515-517.
2. 魯偉, 傅曉青, 楊勇, 等. 加速康復外科在胸外科的應用現狀. 浙江臨床醫學, 2017, 19(11): 2157-2159.
3. Seely AJ, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg, 2010, 90(3): 936-942.
4. 車國衛, 李為民, 劉倫旭. 快速肺康復需要圍手術期流程優化. 中國胸心血管外科臨床雜志, 2016, 23(3): 216-220.
5. 周坤, 吳硯銘, 蘇建華, 等. 肺癌患者術前呼氣峰流速可以預測肺葉切除術后肺部并發癥嗎? 中國肺癌雜志, 2017, 20(9): 603-609.
6. Gallart L, Canet J. Post-operative pulmonary complications: Understanding definitions and risk assessment. Best Pract Res Clin Anaesthesiol, 2015, 29(3): 315-330.
7. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
8. 陳閩江, 柳濤, 蔡柏薔. 2010年英國胸科協會胸腔疾病指南: 成人胸腔感染的診治簡介. 國際呼吸雜志, 2011, 31(12): 881-885.
9. Xue L, Wang L, Dong J, et al. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis. Eur J Cardiothorac Surg, 2017, 52(4): 692-697.
10. Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax, 2010, 65(9): 815-818.
11. Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
12. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
13. Radu DM, Jauréguy F, Seguin A, et al. Postoperative pneumonia after major pulmonary resections: an unsolved problem in thoracic surgery. Ann Thorac Surg, 2007, 84(5): 1669-1673.
14. Lee JY, Jin SM, Lee CH, et al. Risk factors of postoperative pneumonia after lung cancer surgery. J Korean Med Sci, 2011, 26(8): 979-984.
15. 陳子英, 檀振波, 主編. 心胸外科手術并發癥. 第1版. 北京: 軍事醫學科學出版社, 2012. 170-172.
16. 李輝, 姜格寧. 胸部惡性腫瘤圍術期靜脈血栓栓塞癥預防中國專家共識(2018版). 中國肺癌雜志, 2018, 21(10): 739-752.
17. Gaur P, Dunne R, Colson YL, et al. Bronchopleural fistula and the role of contemporary imaging. J Thorac Cardiovasc Surg, 2014, 148(1): 341-347.
18. Alpert JB, Godoy MC, Degroot PM, et al. Imaging the post-thoracotomy patient: anatomic changes and postoperative complications. Radiol Clin North Am, 2014, 52(1): 85-103.
19. Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2009, 22(2): 119-126.
20. 車云, 王亞龍, 譚鋒維, 等. 930例食管癌術后頸部吻合口瘺危險因素分析. 中國腫瘤, 2018, 27(12): 956-961.
21. 黃偉釗, 吳穎猛, 葉紅雨, 等. 食管癌術后消化道瘺的個體化治療. 中國胸心血管外科臨床雜志, 2011, 18(5): 469-471.
22. Schild HH, Strassburg CP, Welz A, et al. Treatment options in patients with chylothorax. Dtsch Arztebl Int, 2013, 110(48): 819-826.
23. Leuzzi G, Meacci E, Cusumano G, et al. Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis. Eur J Cardiothorac Surg, 2014, 45(4): 76-88.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical characteristics and treatment experience of severe complications after thoracic surgery—ten-year outcome from a single center

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