Stratification Of Postoperative Pulmonary Complication(PPC)Risk In Elderly Following Resection Of Lung Cancer

Objectives:Contemporary information about indicators of postoperative pulmonary complications(PPCs)in elderlies with lung cancer following resection is disputable and evolving trends of evaluation and management require an intensive re-examination of the indicators.Subsequently,we evaluated different baseline,clinical and procedure related predictors that other analysts had identified,and the influence of these predictors on transitory outcome linked with PPC and length of hospital stay,to establish a regression equation to predict the risk of PPC in elderly patients with lung cancer.Methods:An observational study retrospective in design was employed on 609 adult patients over 65 years receiving pulmonary resection for lung cancer at a single thoracic institution over the span of 38 months(January 2016 and March 2019).The patients with PPC were selected as the observation group and compared to patients with no PPC,and both groups were matched using Propensity Score(PS)matching(nearest neighbor matching 1:1).PPC was characterized as any one event:respiratory failure,atelectasis,pneumonia,pneumonic embolism,pleural effusion and pneumothorax.The cohort was PS matched and the predictors were assessed.The utilization of Melbourne group scale for PPC prediction,and implication of PPC on post-operative air leak along with hospital LOS was assessed.The risk factors were analyzed by Univariate analyses using Independent sample t-test for continuous data,chi-squared test or continuity correlation for categorical variables and Multivariate analyses using Hierarchical model in binary logistic regression.Results:Among 456 study cohorts who met the inclusion criteria,incidence of PPC was 142(31.1%).The median length of hospitalization(LOS)was significantly greater for PPC group than for those who did not have PPC:20 days vs.24 days,respectively(p<0.0001).Melbourne group score(MGS)scale was statistically significant in assessing PPC on a univariate and multivariate scale(P<0.0001).The propensity score yielded two groups of 135 patients(No PPC group vs.PPC group)well matched for several baseline characteristics.The multivariate logistic regression analysis disclosed American Society of Anesthesiologists(ASA)class>3(odds ratio 0.177,95%confidence interval 0.04-0.85,P=0.03)and Open thoracotomy(odds ratio 0.576,95%confidence interval 0.34-0.99,P=0.04,)as independent risk factors for PPCs.The regression equation "LN(odds)=2.389 +(-1.731)ASA+(-0.552)ST_VATS" can be used in elderlies with lung cancer to assess the risk of postoperative pulmonary complications.Conclusion:Elderly patients with lung cancer have a relatively high incidence of postoperative pulmonary complications,with longer hospital length of stay(LOS)and a Melbourne Group Score(MGS)≥4.PPCs following pulmonary surgery for lung carcinoma are possibly influenced by higher ASA i.e.patients with severe comorbid conditions and surgical technique used,especially Open Thoracotomy,with a likelihood of ninety one percent.Thus,added attention to postoperative strategies and well-tried methods to cut back PPCs ought to be used throughout hospitalization to enhance outcomes in these high-risk groups.