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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21.	黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 2011, 18(5): 469-471.
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1. 王天佑. 我国胸外科发展趋势与分会的任务. 中国肺癌杂志, 2014, 17(7): 515-517.
2. 鲁伟, 傅晓青, 杨勇, 等. 加速康复外科在胸外科的应用现状. 浙江临床医学, 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. 车国卫, 李为民, 刘伦旭. 快速肺康复需要围手术期流程优化. 中国胸心血管外科临床杂志, 2016, 23(3): 216-220.
5. 周坤, 吴砚铭, 苏建华, 等. 肺癌患者术前呼气峰流速可以预测肺叶切除术后肺部并发症吗? 中国肺癌杂志, 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. 陈闽江, 柳涛, 蔡柏蔷. 2010年英国胸科协会胸腔疾病指南: 成人胸腔感染的诊治简介. 国际呼吸杂志, 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. 陈子英, 檀振波, 主编. 心胸外科手术并发症. 第1版. 北京: 军事医学科学出版社, 2012. 170-172.
16. 李辉, 姜格宁. 胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识(2018版). 中国肺癌杂志, 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. 车云, 王亚龙, 谭锋维, 等. 930例食管癌术后颈部吻合口瘘危险因素分析. 中国肿瘤, 2018, 27(12): 956-961.
21. 黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 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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