Risk factors of persistent cough after pneumonectomy: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QUAN Dandan ^1,2 ,  HONG Jingfang ¹ , ZHANG Tian ² , LI Congling ²

1. School of Nursing, Anhui Medical University, Hefei, 230032, P. R. China;
2. Department of Thoracic Surgery, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230000, P. R. China;

Corresponding author：

HONG Jingfang, Email: hjftong@ahmu.edu.cn

Keywords：

Pneumonectomy; persistent cough; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202307014

Video：

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Objective To systematically evaluate the risk factors for persistent cough after lung resection, providing a theoretical basis for preventing persistent postoperative cough. Methods The Cochrane Library, Web of Science, EMbase, PubMed, Chinese Biomedical Literature Database, Wanfang, CNKI, and VIP databases were searched for studies related to risk factors for persistent cough after lung resection. The search period was from database inception to March 30, 2023. Two researchers independently screened the literature, extracted data, and performed quality assessment. RevMan 5.3 software was used for meta-analysis. Results A total of 17 articles with 3 698 patients were included. Meta-analysis results showed that females [OR=3.10, 95%CI (1.99, 4.81), P<0.001], age [OR=1.72, 95%CI (1.33, 2.21), P<0.001], right-sided lung surgery [OR=2.36, 95%CI (1.80, 3.10), P<0.001], lobectomy [OR=3.40, 95%CI (2.47, 4.68), P<0.001], upper lobectomy [OR=8.19, 95%CI (3.87, 17.36), P<0.001], lymph node dissection [OR=3.59, 95%CI (2.72, 4.72), P<0.001], bronchial stump closure method [OR=5.19, 95%CI (1.79, 16.07), P=0.002], and postoperative gastric acid reflux [OR=6.24, 95%CI (3.27, 11.91), P<0.001] were risk factors for persistent cough after lung resection, while smoking history was a protective factor against postoperative cough [OR=0.59, 95%CI (0.45, 0.77), P<0.001]. In addition, the quality of life score of patients with postoperative cough decreased compared with that before surgery [MD=1.50, 95%CI (0.14, 2.86), P=0.03]. Conclusion Current evidence suggests that females, age, right-sided lung surgery, lobectomy, upper lobectomy, lymph node dissection, bronchial stump closure method (stapler closure), and postoperative gastric acid reflux are independent risk factors for persistent postoperative cough in lung resection patients, while smoking history may be a protective factor against postoperative cough. This provides evidence-based information for clinical medical staff on how to prevent and reduce persistent postoperative cough in patients and improve their quality of life in the future.

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1. Sawabata N, Maeda H, Takeda S, et al. Persistent cough following pulmonary resection: Observational and empiric study of possible causes. Ann Thorac Surg, 2005, 79(1): 289-293.
2. Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest, 2004, 125(2): 439-445.
3. Liao J, Wang Y, Dai W, et al. Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: A cross-sectional analysis. J Cardiothorac Surg, 2022, 17(1): 229.
4. Molassiotis A, Smith JA, Mazzone P, et al. Symptomatic treatment of cough among adult patients with lung cancer: CHEST guideline and expert panel report. Chest, 2017, 151(4): 861-874.
5. Xie MR, Zhu YF, Zhou MQ, et al. Analysis of factors related to chronic cough after lung cancer surgery. Thorac Cancer, 2019, 10(4): 898-903.
6. 慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017, 17(7): 577-580.Mu T, Jiang GC, Li X, et al. Multivariate analysis of persistent cough after pulmonary resection by video-assisted thoracoscopic surgery. Chin J Minim Invasive Surg, 2017, 17(7): 577-580.
7. Lu XF, Min XP, Lu B, et al. Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients. Quant Imaging Med Surg, 2022, 12(1): 196-206.
8. Wu X, Xing H, Chen P, et al. Lymph node dissection is a risk factor for short-term cough after pulmonary resection. Curr Oncol, 2022, 29(1): 294-307.
9. 张奕, 解纲, 李波. 非小细胞肺癌患者电视胸腔镜术后慢性咳嗽的影响因素及治疗. 中国肿瘤临床与康复, 2022, 29(3): 299-302.Zhang Y, Xie G, Li B. Influencing factors and treatment of chronic cough after video-assisted thoracoscopic surgery for non-small cell lung cancer. Chin J Clin Oncol Rehabil, 2022, 29(3): 299-302.
10. 马涵. 胸腔镜下肺肿瘤术后慢性咳嗽的临床研究. 苏州大学, 2019.Ma H. Clinical research on chronic cough after video assist thoracoscopic surgery for pulmonary tumors. Suzhou University, 2019.
11. 钱鹏, 朱峰, 马冬春, 等. 接受单孔胸腔镜肿瘤切除术治疗非小细胞肺癌患者术后出现持续性咳嗽的危险因素. 山东医药, 2021, 61(9): 74-76.Qian P, Zhu F, Ma DC, et al. Risk factors for persistent cough in patients undergoing single-port thoracoscopic tumor resection for non-small cell lung cancer. Shandong Med J, 2021, 61(9): 74-76.
12. 吴子恒, 徐惟, 许世广, 等. 达芬奇机器人与电视胸腔镜非小细胞肺癌术后慢性咳嗽危险因素分析及应对策略. 中国胸心血管外科临床杂志, 2020, 27(11): 1274-1280.Wu ZH, Xu W, Xu SG, et al. Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(11): 1274-1280.
13. 辛五群, 陈晓, 汤金星, 等. 肺癌经胸腔镜切除术后继发持续性咳嗽的影响因素分析. 结核病与肺部健康杂志, 2021, 2(1): 31-37.Xin WQ, Chen X, Tang JX, et al. Factors of persistent cough secondary to thoracoscopic resection of lung cancer. J Tuberc Lung Dis, 2021, 2(1): 31-37.
14. Pan LY, Peng LP, Xu C, et al. Predictive factors of cough after uniportal video-assisted thoracoscopic pulmonary resection. J Thorac Dis, 2020, 12(10): 5958-5969.
15. 崔慧琴, 王舒蓉, 顾玉晶. 老年肺癌患者胸腔镜下肺癌切除术后继发持续性咳嗽的危险因素探讨. 老年医学与保健, 2023, 29(1): 63-67.Cui HQ, Wang SR, Gu YJ. Risk factors of persistent cough secondary to thoracoscopic lung cancer resection in elderly patients. Geriatr Health Care, 2023, 29(1): 63-67.
16. 董仙英, 徐琪纹, 钟娟. 肺癌患者术后并发慢性咳嗽的危险因素分析. 护士进修杂志, 2022, 37(9): 783-786.Dong XY, Xu QW, Zhong J. Analysis of the risk factors of postoperative chronic cough in the patients with lung cancer. J Nurses Train, 2022, 37(9): 783-786.
17. 董艳, 孟醒, 刘旭岚, 等. 肺癌胸腔镜肺切除术后发生持续咳嗽的相关危险因素分析. 航空航天医学杂志, 2022, 33(12): 1475-1477.Dong Y, Meng X, Liu XL, et al. Risk factors of persistent cough after thoracoscopic pneumonectomy for lung cancer. J Aerospace Med, 2022, 33(12): 1475-1477.
18. 高永山, 张志杰, 付伟, 等. 非小细胞肺癌经单操作孔胸腔镜肺段切除术后并发持续咳嗽的危险因素分析. 山东医药, 2022, 62(11): 77-79.Gao YS, Zhang ZJ, Fu W, et al. Risk factors analysis of persistent cough after thoracoscopic segmental resection of non-small cell lung cancer. Shandong Med J, 2022, 62(11): 77-79.
19. 贺静晗, 崔璨, 贾宇, 等. 非小细胞肺癌患者胸腔镜手术后持续咳嗽发生的影响因素. 国际医药卫生导报, 2022, 28(16): 2241-2245.He JH, Cui C, Jia Y, et al. Influencing factors of persistent cough in patients with non-small cell lung cancer after thoracoscopic surgery. Int Med Health Guid News, 2022, 28(16): 2241-2245.
20. 李理响, 汪国文, 王康武, 等. 肺切除术后不可耐受性咳嗽的危险因素分析. 中华解剖与临床杂志, 2022, 27(7): 491-495.Li LX, Wang GW, Wang KW, et al. Analysis of risk factors of intolerable cough after pneumonectomy. Chin J Anat Clin, 2022, 27(7): 491-495.
21. 马志飞, 张爱平, 黄福华, 等. 非小细胞肺癌患者肺叶切除术后持续干咳的影响因素. 江苏医药, 2022, 48(9): 887-890.Ma ZF, Zhang AP, Huang FH, et al. Influencing factors for persistent dry cough in patients with non-small cell lung cancer after pulmonary lobectomy. Jiangsu Med J, 2022, 48(9): 887-890.
22. 殷优宏, 戎国祥, 张帆. 非小细胞肺癌患者电视胸腔镜微创术后发生慢性咳嗽的影响因素. 中国当代医药, 2021, 28(36): 80-82.Yin YH, Rong GX, Zhang F. Influencing factors of chronic cough in patients with non-small cell lung cancer after minimally invasive video-assisted thoracoscopic surgery. Chin Mod Med, 2021, 28(36): 80-82.
23. 中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2015). 中华结核和呼吸杂志, 2016, 39(5): 323-354.Asthma Group, Respiratory Society, Chinese Medical Association. Guideline on diagnosis and management of cough (2015). Chin J Tuberc Respir Dis, 2016, 39(5): 323-354.
24. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129(1 Suppl): 1S-23S.
25. Kavalcikova-Bogdanova N, Buday T, Plevkova J, et al. Chronic cough as a female gender issue. Adv Exp Med Biol, 2016, 905: 69-78.
26. Morice AH, Jakes AD, Faruqi S, et al. A worldwide survey of chronic cough: A manifestation of enhanced somatosensory response. Eur Respir J, 2014, 44(5): 1149-1155.
27. Dicpinigaitis PV. Cough reflex sensitivity in cigarette smokers. Chest, 2003, 123(3): 685-688.
28. Dicpinigaitis PV. Effect of tobacco and electronic cigarette use on cough reflex sensitivity. Pulm Pharmacol Ther, 2017, 47: 45-48.
29. Dicpinigaitis PV, Sitkauskiene B, Stravinskaite K, et al. Effect of smoking cessation on cough reflex sensitivity. Eur Respir J, 2006, 28(4): 786-790.
30. Dicpinigaitis PV, Lee Chang A, Dicpinigaitis AJ, et al. Effect of e-cigarette use on cough reflex sensitivity. Chest, 2016, 149(1): 161-165.
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