Unplanned reoperation after pulmonary surgery: Rate, risk factors and early outcomes at a single center

Kuan Xu; Ermei Xie; Yilv Lv; Wei Gu; Minjun Shi; Jueya Yao; Jingxiang Wu; Bo Ye

doi:10.1016/j.heliyon.2023.e20538

Unplanned reoperation after pulmonary surgery: Rate, risk factors and early outcomes at a single center

Heliyon. 2023 Sep 30;9(10):e20538. doi: 10.1016/j.heliyon.2023.e20538. eCollection 2023 Oct.

Authors

Kuan Xu¹, Ermei Xie^{2

3}, Yilv Lv¹, Wei Gu⁴, Minjun Shi¹, Jueya Yao⁵, Jingxiang Wu⁴, Bo Ye¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
² Key Laboratory of Synthetic Biology Regulatory Element, Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Suzhou Institute of Systems Medicine, Suzhou, China.
⁴ Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
⁵ Department of General Surgery Department, Shanghai Construction Group Hospital, Shanghai, 200030, China.

Abstract

Background: Unplanned reoperation is a potential risk factor for worse prognoses and reflects the quality of surgical treatment. This study compared the short-term outcomes between patients with and without reoperation and identified clinical factors predicting reoperation within 90 days following pulmonary surgery.

Methods: Consecutive patients undergoing pulmonary resection from January 2012 to August 2021 at our institution were retrospectively reviewed. Clinical and operation-related data were collected and analyzed. Kaplan‒Meier, Cox hazard proportional regression, and propensity score matching were adopted for prognostic evaluation.

Results: A total of 90263 patients were included: 247 (0.27%) patients required reoperation within 90 days. Patients undergoing unplanned reoperation had higher mortality and more postoperative complications than the nonreoperation group. Reoperation within 24 h was associated with reduced odds of mortality relative to reoperation beyond 24 h. Independent risk factors for unplanned reoperation were male sex, benign lung disease, specific surgical locations, lobectomy, and pneumonectomy. A history of smoking, pulmonary tuberculosis, intraoperative pleural adhesion, and postoperative complications were also identified as predisposing factors. The most common complication was hemorrhage in 75.7% (187 of 247).

Conclusion: Our study found that unplanned reoperation was a rare but serious event that increased the risk of postoperative complications and mortality. We identified several risk factors that could be used to stratify patients according to their reoperation risk and suggest that high-risk patients should receive more intensive monitoring and preventive measures. Moreover, our study indicated that reoperating within 24 h could improve the outcomes for patients who needed reoperation.

Keywords: Reoperation; Thoracic surgery; Treatment outcome.