Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JI Yanli ^1,2 , JIANG Chulaerbu ³ ,  WANG Wenping ² , HU Yang ² , MA Lin ² , YUAN Yong ² , LIN Feng ² , CHE Guowei ²

1. Department of Thoracic Surgery, West China Hospital, Sichuan University/School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, 626000, Sichuan, P. R. China;

Corresponding?author：

WANG Wenping, Email: drwangwp@163.com

Keywords：

High-altitude resident; high-altitude medical center; thoracic surgery; postoperative complications

DOI：

10.7507/1007-4848.202111050

Video：

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Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. Methods We retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. Results The rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m² (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). Conclusion Thoracic surgery in the high-altitude medical center is safe and feasible.

Citation： JI Yanli, JIANG Chulaerbu, WANG Wenping, HU Yang, MA Lin, YUAN Yong, LIN Feng, CHE Guowei. Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 95-99. doi: 10.7507/1007-4848.202111050 Copy

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2.	Lei S, Sun Z, He X, et al. Clinical characteristics of pulmonary hypertension patients living in plain and high-altitude regions. Clin Respir J, 2019, 13(8): 485-492.
3.	Wilkins MR, Ghofrani HA, Weissmann N, et al. Pathophysiology and treatment of high-altitude pulmonary vascular disease. Circulation, 2015, 131(6): 582-590.
4.	馬宏偉, 丁麗景, 周艷杰, 等. 高原地區手術患者全身麻醉的臨床處理. 山西醫藥雜志, 2019, 48(3): 279-283.
5.	劉剛, 魏秀玲, 楊林江, 等. 中度高海拔地區開胸手術對肺泡表面活性物質的影響. 中華胸部外科電子雜志, 2015, 2(2): 119-122.
6.	潘韞丹, 牛姣姣, 覃罡, 等. 西藏先天性心臟病患兒在低海拔地區行手術麻醉的圍手術期安全性. 中南大學學報(醫學版), 2017, 42(11): 1288-1292.
7.	德慶多吉. 不同海拔對術后切口感染情況分析. 西藏醫藥, 2020, 41(5): 56-57.
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11.	王朋飛, 代偉娜, 劉禮新, 等. 高體質量指數對胸腔鏡下肺癌根治術圍術期并發癥及臨床療效的影響. 腫瘤研究與臨床, 2019, 31(3): 167-171.
12.	劉杰, 吳穹, 李英蓮, 等. 高海拔地區高TC、高TG、高GLU血癥與高血壓、肥胖的調查分析. 高原醫學雜志, 2012, 22(2): 13-17.
13.	劉剛, 魏秀玲, 楊林江, 等. 中度高海拔地區肺部手術后早期使用低分子肝素抗凝對凝血功能的影響及安全性. 廣東醫學, 2016, 37(6): 871-873.
14.	Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg, 2011, 39(5): 738-744.
15.	Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
16.	王朋飛. 應用傾向評分匹配法評價術前體重指數對非小細胞肺癌圍手術期及遠期預后的影響. 蘭州大學, 2020.
17.	Chang MY, Chang ML, Wu CT. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report. World J Gastroenterol, 2006, 12(44): 7213-7215.
18.	Bellaiche S, Di Blasio R, Luauté J, et al. Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med, 2013, 56(1): 41-50.
19.	周乃康, 崔忠厚, 王芳澤. 胸外科疾病病案分析. 北京: 科學出版社, 2006. 154-159.
20.	Dayen C, Mishellany H, Hellmuth D, et al. Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature. Rev Mal Respir, 2001, 18(5): 537-540.

1. Pasha MA, Newman JH. High-altitude disorders: Pulmonary hypertension: Pulmonary vascular disease: The global perspective. Chest, 2010, 137(6 Suppl): 13S-19S.
2. Lei S, Sun Z, He X, et al. Clinical characteristics of pulmonary hypertension patients living in plain and high-altitude regions. Clin Respir J, 2019, 13(8): 485-492.
3. Wilkins MR, Ghofrani HA, Weissmann N, et al. Pathophysiology and treatment of high-altitude pulmonary vascular disease. Circulation, 2015, 131(6): 582-590.
4. 馬宏偉, 丁麗景, 周艷杰, 等. 高原地區手術患者全身麻醉的臨床處理. 山西醫藥雜志, 2019, 48(3): 279-283.
5. 劉剛, 魏秀玲, 楊林江, 等. 中度高海拔地區開胸手術對肺泡表面活性物質的影響. 中華胸部外科電子雜志, 2015, 2(2): 119-122.
6. 潘韞丹, 牛姣姣, 覃罡, 等. 西藏先天性心臟病患兒在低海拔地區行手術麻醉的圍手術期安全性. 中南大學學報(醫學版), 2017, 42(11): 1288-1292.
7. 德慶多吉. 不同海拔對術后切口感染情況分析. 西藏醫藥, 2020, 41(5): 56-57.
8. Xu R, Zhou S, Yang J, et al. Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude. J Int Med Res, 2017, 45(1): 246-253.
9. Grimminger J, Richter M, Tello K, et al. Thin air resulting in high pressure: Mountain sickness and hypoxia-induced pulmonary hypertension. Can Respir J, 2017, 2017: 8381653.
10. Swenson ER, B?rtsch P, eds. High Altitude: Human Adaptation to Hypoxia. Germany: Springer, 2014.
11. 王朋飛, 代偉娜, 劉禮新, 等. 高體質量指數對胸腔鏡下肺癌根治術圍術期并發癥及臨床療效的影響. 腫瘤研究與臨床, 2019, 31(3): 167-171.
12. 劉杰, 吳穹, 李英蓮, 等. 高海拔地區高TC、高TG、高GLU血癥與高血壓、肥胖的調查分析. 高原醫學雜志, 2012, 22(2): 13-17.
13. 劉剛, 魏秀玲, 楊林江, 等. 中度高海拔地區肺部手術后早期使用低分子肝素抗凝對凝血功能的影響及安全性. 廣東醫學, 2016, 37(6): 871-873.
14. Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg, 2011, 39(5): 738-744.
15. Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
16. 王朋飛. 應用傾向評分匹配法評價術前體重指數對非小細胞肺癌圍手術期及遠期預后的影響. 蘭州大學, 2020.
17. Chang MY, Chang ML, Wu CT. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report. World J Gastroenterol, 2006, 12(44): 7213-7215.
18. Bellaiche S, Di Blasio R, Luauté J, et al. Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med, 2013, 56(1): 41-50.
19. 周乃康, 崔忠厚, 王芳澤. 胸外科疾病病案分析. 北京: 科學出版社, 2006. 154-159.
20. Dayen C, Mishellany H, Hellmuth D, et al. Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature. Rev Mal Respir, 2001, 18(5): 537-540.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center

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