Risk Factor Analysis Including Inflammatory Markers for ICU Admission and Survival After Pneumonectomy.

Area of Science:

• Cardiothoracic Surgery
• Surgical Outcomes
• Inflammatory Markers

Background:

• Pneumonectomy is a major surgical procedure with significant associated morbidity and mortality.
• Identifying predictors of intensive care unit (ICU) admission and survival is crucial for optimizing patient management.
• Preoperative inflammatory parameters may influence outcomes after major thoracic surgery.

Purpose of the Study:

• To evaluate the association between preoperative inflammatory markers and the need for ICU admission following pneumonectomy.
• To identify risk factors for short-term (28-day) and medium-term (90-day) mortality after pneumonectomy.
• To assess the impact of specific surgical techniques and intraoperative events on patient outcomes.

Main Methods:

• A retrospective analysis of 207 adult patients who underwent pneumonectomy between December 2016 and January 2022.
• Data were collected from electronic medical records, including preoperative laboratory values and intraoperative/postoperative events.
• Multivariate analysis was employed to identify independent predictors of ICU admission and mortality.

Main Results:

• Lower preoperative albumin and higher need for blood transfusion were observed in ICU-admitted patients.
• Intra-pericardial pneumonectomy and postoperative complications were independent predictors of ICU admission.
• Factors associated with 28-day mortality included sleeve/pericardial pneumonectomy, vascular injury, mechanical ventilation, renal failure, sepsis, respiratory failure, pneumonia, blood transfusion, elevated BUN, and creatinine.
• Higher preoperative neutrophil-to-lymphocyte ratio (NLR), creatinine, sleeve/intra-pericardial pneumonectomy, mechanical ventilation, vascular injury, sepsis, respiratory failure, and contralateral pneumonia were associated with 90-day mortality.

Conclusions:

• Intra-pericardial pneumonectomy and postoperative complications are significant predictors of ICU admission post-pneumonectomy.
• Preoperative inflammatory markers (NLR, BUN, creatinine) and surgical factors (sleeve/intra-pericardial procedures, intraoperative complications, blood transfusion) are associated with increased mortality risk.