Secondary analysis of preoperative predictors for acute postoperative exacerbation in interstitial lung disease

This study assessed whether perioperative management is associated with postoperative acute exacerbations (AEs) in interstitial lung disease (ILD) patients. Using secondary data from the study "Postoperative acute exacerbation of interstitial lung disease: a case-control study," we compared the perioperative clinical management of the AE and non-AE groups (1:4 case-control matching) selected by sex, year of surgery (2009-2011, 2012-2014, and 2015-2017), and multiple surgeries within 30 days. We compared 27 and 108 patients with and without AEs, respectively. Rates of one lung ventilation (OLV) cases (70 vs. 29%; OR, 5.9; 95%CI, 2.34-14.88; p < 0.001) and intraoperative steroid administration (48 vs. 26%; OR, 2.65; 95%CI, 1.11-6.33; p = 0.028), and average mean inspiratory pressure (9.2 [1.8] vs. 8.3 [1.7] cmH₂O; OR, 1.36; 95%CI, 1.04-1.79; p = 0.026), were significantly higher in the AE group. There was a significant difference in OLV between the groups (OR, 4.99; 95%CI, 1.90-13.06; p = 0.001). However, the fraction of inspired oxygen  > 0.8 lasting > 1 min (63 vs. 73%, p = 0.296) was not significantly different between the groups. OLV was significantly associated with postoperative AEs in patients with ILD undergoing both pulmonary and non-pulmonary surgeries. Thus, preoperative risk considerations are more important in patients who require OLV.