Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study
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REPORTS OF ORIGINAL INVESTIGATIONS
Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study Facteurs de risque pe´riope´ratoires des patients atteints de fibrose pulmonaire idiopathique : une e´tude de cohorte historique Brittany J. McDowell, MD . Kunal Karamchandani, MD . Erik B. Lehman, MD . Matthew J. Conboy, BA . Zyad J. Carr, MD FASA Received: 27 January 2020 / Revised: 26 July 2020 / Accepted: 10 August 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Perioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients. Methods We performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adjust for multiple interactions, the false discovery rate (Q value) was utilized to appropriately adjust P values and a Q value \ 0.05 was considered to be significant. B. J. McDowell, MD K. Karamchandani, MD Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA Penn State University College of Medicine, Hershey, PA, USA E. B. Lehman, MD Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA M. J. Conboy, BA Penn State University College of Medicine, Hershey, PA, USA Z. J. Carr, MD FASA (&) Department of Anesthesiology, Yale New Haven Hospital, 20 York St., New Haven, CT 06510, USA e-mail: [email protected] Yale School of Medicine, New Haven, CT, USA
Results Two hundred and eighty-two patients were identified. After excluding emergency cases and bronchoscopies performed for active pneumonia, 14.2% of the cohort developed ARW that persisted [ 24 hr after surgery, 5.0% had AE-IPF, and 9.2% were diagnosed with postoperative pneumonia within 30 days of surgery. The 30-day mortality was 6.0% and the one-year mortality was 14.9%. Preoperative home oxygen use (relative risk [RR], 2.70; 95% confidence interval [CI], 1.50 to 4.86; P \ 0.001) and increasing surgical time (per 60 min) (RR, 1.03; 95% CI, 1.02 to 1.05; P \ 0.001) were identified as independent risk factors for postoperative ARW. Conclusions In IPF patients, preoperative home oxygen requirement and increasing surgical time showed a strong relationship with postoperative ARW and may be useful markers for perioperative risk stratification. Facteurs de risque pe´riope´ratoires des patients atteints de fibrose pulmonaire idiopathique : une e´tude de cohorte historique Re´sume´ Objectif Les complications pe´riope´ratoires chez les patients atteints de fibrose pulmonaire idiopathique (FPI) ne sont pas bien de´crites. L’objectif de cette
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