Incidence and risk factors for lung injury after lung cancer resection

Background. Lung injury, defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after major anatomic pulmonary resection. Our objective was to identify the incidence and risk factors for the development of postoperative lung injury. Methods. A retrospective case-control study of consecutive patients undergoing resection for lung cancer at a single institution was performed. The severity of lung injury was defined using the American European Consensus Conference on ARDS ( acute respiratory distress syndrome) criteria and the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html). Patients with lung injury were compared with matched control patients, based on age, sex, and extent of resection, for examination of a priori defined risk factors. Results. From January 2001 to June 2004, 1,428 patients underwent attempted curative lung cancer resection. Postoperative lung injury occurred in 76 (5.3%) cases, 44(3.1%) of which met criteria for acute lung injury or acute respiratory distress syndrome. After matching, there were no differences between cases and control patients with respect to use of induction therapy, perioperative transfusions, or tumor laterality. After univariate and multivariate analysis, increasing perioperative fluid administration and decreasing postoperative predicted lung function were significant risk factors for the development of lung injury. The overall mortality for patients with lung injury was 25%, compared with 2.6% for the control group. Conclusions. Lung injury after lung resection has a high mortality. Lower predicted postoperative lung function, especially diffusion capacity, in combination with greater perioperative fluid administration were significant predictors of postoperative lung injury.