■高达40%的肺叶切除术并发不良事件。胃食管反流病(GERD)和食管裂孔疝在一系列临床情景中与发病率相关。然而,它们与肺切除术后恢复的关系尚未得到充分研究。我们评估了GERD和食管裂孔疝作为肺癌肺叶切除术后并发症的预测因子。
■评估2014年1月至2021年4月在耶鲁-纽黑文医院行肺叶切除术的患者术后30天并发症的预测因素,肺炎,房性心律失常,重新接纳,和死亡率。多变量回归模型包括社会人口统计学特征,身体质量指数,手术方法,心肺合并症,食管裂孔疝,GERD,和术前抑酸治疗作为预测因子。
■总的来说,824例患者接受了肺叶切除术,包括50.5%的食管裂孔疝和38.7%的GERD。中位年龄为68[四分位距,61-74年,大多数是女性(58.4%)。39.6%的患者发生至少1例术后并发症,包括房性心律失常(11.7%)和肺炎(4.1%)。男性(赔率比[OR],1.51;95%置信区间[CI],1.11-2.06,P=.01),年龄≥70岁(或,1.55;95%CI,1.13-2.11,P=0.01),食管裂孔疝(或,1.40;95%CI,1.03-1.90,P=0.03),和术中填充的红细胞(OR,4.80;95%CI,1.51-15.20,P=0.01)是发生至少1次术后并发症的重要危险因素。食管裂孔疝也是房性心律失常的重要预测因子(OR,1.64;95%CI,1.02-2.62,P=.04),但与其他不良事件无关。
■我们的研究结果表明,食管裂孔疝可能是并发症的新危险因素,尤其是房性心律失常,肺叶切除术后,在肺癌患者的术前评估中应考虑。
UNASSIGNED: Up to 40% of lobectomies are complicated by adverse events. Gastroesophageal reflux disease (GERD) and hiatal hernia have been associated with morbidity across a range of clinical scenarios, yet their relation to recovery from pulmonary resection is understudied. We evaluated GERD and hiatal hernia as predictors of complications after lobectomy for lung cancer.
UNASSIGNED: Lobectomy patients at Yale-New Haven Hospital between January 2014 and April 2021 were evaluated for predictors of 30-day postoperative complications, pneumonia, atrial arrhythmia, readmission, and mortality. Multivariable regression models included sociodemographic characteristics, body mass index, surgical approach, cardiopulmonary comorbidities, hiatal hernia, GERD, and preoperative acid-suppressive therapy as predictors.
UNASSIGNED: Overall, 824 patients underwent lobectomy, including 50.5% with a hiatal hernia and 38.7% with GERD. The median age was 68 [interquartile range, 61-74] years, and the majority were female (58.4%). At least 1 postoperative complication developed in 39.6% of patients, including atrial arrhythmia (11.7%) and pneumonia (4.1%). Male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.11-2.06, P = .01), age ≥70 years (OR, 1.55; 95% CI, 1.13-2.11, P = .01), hiatal hernia (OR, 1.40; 95% CI, 1.03-1.90, P = .03), and intraoperative packed red blood cells (OR, 4.80; 95% CI, 1.51-15.20, P = .01) were significant risk factors for developing at least 1 postoperative complication. Hiatal hernia was also a significant predictor of atrial arrhythmia (OR, 1.64; 95% CI, 1.02-2.62, P = .04) but was not associated with other adverse events.
UNASSIGNED: Our findings indicate that hiatal hernia may be a novel risk factor for complications, especially atrial arrhythmia, following lobectomy that should be considered in the preoperative evaluation of lung cancer patients.