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Predictors associated with Clavien-Dindo complications in lung cancer surgery: A retrospective cohort study
Mantana Saetang1, Thitikan Kunapaisal1, Wirat Wasinwong1
1Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
Background:
To highlight the risk assessment tool associated with postoperative cardiopulmonary complications of Clavien-Dindo (CD) ≥ II in elderly patients who underwent lung cancer surgery.
Methods:
In patients ≥ 60 years admitted during 2020-2023 and having undergone lung cancer surgery, postoperative cardiopulmonary complications were examined using the CD classification as groups (CD grade I versus ≥ II), and the risk factors were analyzed using logistic regression and receiver operating characteristic (ROC) curves.
Results:
Of the 239 elderly patients, 29.3% had postoperative complications (CD ≥ II). Subgroup analysis revealed that patients aged ≥70 years had a higher rate of postoperative complications compared to those aged 60-69 years, however, this relationship was not statistically significant in the multivariable model (OR: 2.03, 95% CI: 0.95-4.36, p = 0.068). The CD grade ≥ II group had longer surgical time (p = 0.002), greater postoperative pulmonary complications (p < 0.001), and longer length of hospital stay (p < 0.001); CD grade ≥ II was more likely in patients with older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.02-1.15, p = 0.011), COPD (OR: 4.41, 95% CI: 1.55-13.44, p = 0.005) and smoking history (OR: 2.85, 95% CI: 1.12-7.24, p = 0.028), having undergone pneumonectomy (OR: 14.89, 95% CI: 1.71-334.9, p = 0.045), and who converted to open thoracotomy (OR: 16.33, 95% CI: 2.13-169.71, p = 0.007). The area under the ROC curve was 0.81.
Conclusions:
Older age (≥70 years) is associated with higher rates of postoperative complications (CD classification ≥ II) but is not an independent predictor when adjusting for other factors. Comorbidities such as COPD and surgical factors, including pneumonectomy and conversion to thoracotomy, are significant contributors. These findings emphasize the need for comprehensive, multifactorial risk assessments to guide perioperative management and improve outcomes in elderly lung cancer patients.
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