Risk Factors Related to Postoperative Acute Exacerbation in Patients with Interstitial Lung Disease

Patients with interstitial lung disease (ILD) often experience postoperative acute exacerbation (AE). There is a lack of consensus regarding the risk factors for postoperative AE. This study aimed to identify factors associated with postoperative AE in patients with ILD.

Of 84,833 patients who underwent surgery under general anesthesia, we included 198 ILD patients. The patients were retrospectively divided into AE and non-AE groups. Exclusion criteria were those who were continuously on a ventilator preoperatively or postoperatively, and those with obvious infection. We investigated risk factors, adjusting for sex and pulmonary surgery.

AE occurred within 30 days after surgery in 11 patients (5.6%) and six of these patients (55%) died. Preoperative C-reactive protein (CRP) levels were significantly higher in the AE group than in the non-AE group (OR, 1.06; 95% confidence interval [CI], 1.00-1.13; p = 0.048). Chest high-resolution computed tomography (CT) evaluation was performed according to the updated 2022 idiopathic pulmonary fibrosis guidelines. CT revealed that patients in the CT-defined usual interstitial pneumonia (UIP) group, comprising UIP and probable UIP patterns, were significantly more likely to experience AE than those in the non-CT-UIP group, which included indeterminate UIP and alternative diagnosis patterns (OR, 4.00; 95% CI, 1.19-15.04; p = 0.025).

In patients with ILD, the risk of postoperative AE across all surgeries, including non-pulmonary surgery, was associated with high preoperative CRP levels and the CT-UIP pattern.