Elective pneumonectomy: Factors associated with morbidity and operative mortality

We have retrospectively reviewed hospital records of 197 consecutive patients undergoing pneumonectomy for neoplastic disease between 1985 and 1990 to identify predictors of outcome. Seventeen of the 197 patients died during their hospital stay (8.6%; 95% confidence intervals, 6.7% to 11.2%). The most significant predictors of in-hospital mortality were presence of coexisting medical conditions ( p < 0.001), respiratory function tests showing an obstructive picture with a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.55 ( p < 0.001), 24-hour fluid replacement of more than 3 L ( p < 0.05), postoperative pulmonary edema ( p < 0.001), respiratory tract infection with positive sputum culture ( p < 0.01), postoperative renal failure ( p < 0.001), and cardiac arrhythmias ( p < 0.001). There were 232 postoperative management problems occurring in 197 patients. The most significant predictors of postoperative morbidity were continued cigarette smoking up to the time of operation ( p < 0.05), perioperative blood loss or more than 2 L ( p < 0.05), and infusion of more than 3 L of fluid in the first 24 hours ( p < 0.05). Although retrospective analyses must be interpreted with caution, this study has identified preoperative and perioperative factors associated with in-hospital morbidity and mortality after pneumonectomy.