Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up

Hongyun Ruan; Yunsong Li; Yuxuan Wang; Fangchao Liu; Dongdong Hou; Changfan Gong; Jinxiang Wang; Zhidong Liu

doi:10.21037/jtd-22-610

Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up

J Thorac Dis. 2022 Oct;14(10):3737-3747. doi: 10.21037/jtd-22-610.

Authors

Hongyun Ruan^#¹, Yunsong Li^#², Yuxuan Wang^#², Fangchao Liu³, Dongdong Hou⁴, Changfan Gong², Jinxiang Wang⁵, Zhidong Liu²

Affiliations

¹ Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
² Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
³ Department of Science and Technology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
⁴ Department of Medical Oncology of Peking University Shougang Hospital, Beijing, China.
⁵ Department of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background: Although pneumonectomy is an important surgical treatment for tuberculosis-destroyed lung (TDL), few studies have investigated long-term postoperative TDL prognosis. Here, risk factors were determined for postoperative secondary respiratory failure and modified British Medical Research Council (mMRC ≥1) at discharge and at 1-year post-surgical follow-up.

Methods: A two-way cohort study was conducted of 116 patients admitted to our thoracic surgery department for surgical TDL treatment from January 2001 to June 2020. General clinical data were collected then patient postoperative mMRC scores were monitored for 1 year. Dyspnea-associated factors (mMRC ≥1) were identified then risk factors for postoperative respiratory failure and compromised long-term respiratory function were identified using multivariate adjusted logistic regression analysis.

Results: Of 116 patients, 27.6% (32/116) developed respiratory failure secondary to surgery. Multifactorial logistic regression analysis revealed that preoperative serum albumin of <30 g/L [adjusted odds ratios (aOR) 6.613, 95% confidence intervals (CI): 1.064-41.086] and intraoperative bleeding of >1,000 mL (aOR 6.876, 95% CI: 1.236-38.243) were risk factors for subsequent respiratory failure only in patients experiencing postoperative secondary respiratory failure. Sorting of patient mMRC dyspnea index scores into two groups (mMRC =0, mMRC ≥1) followed by logistic regression analysis revealed that risk factors for 1-year postoperative dyspnea included mMRC score ≥1 at discharge (aOR 14.446, 95% CI: 1.102-189.361) and postoperative respiratory failure occurrence (aOR 9.946, 95% CI: 1.063-93.034).

Conclusions: TDL patient preoperative hypoalbuminemia and extensive intraoperative bleeding were risk factors for postoperative secondary respiratory failure. Postoperative secondary respiratory failure and high mMRC (≥1) at discharge were associated with reduced postoperative long-term recovery of respiratory function.

Keywords: Tuberculosis-destroyed lung (TDL); modified British Medical Research Council (mMRC); postoperative; respiratory failure; surgical treatment.