| Mortality and factors associated with acute exacerbation after noncardiac surgery in patients with interstitial pneumonia: a retrospective study |
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Kaoru Umehara1, Kazuhiro Shirozu1, Taichi Ando1, Kentaro Tokuda2, Kei Makishima3, Kazuya Imura4, Shota Tsumura4, Shinnosuke Takamori3, Ken Yamaura3 |
1Operating Rooms, Kyushu University Hospital, Fukuoka, Japan
2Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan
3Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
4Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan |
Corresponding author:
Kazuhiro Shirozu, Tel: +81-92-642-5714 , Fax: +81-92-642-5722,
Email: shirozu.kazuhiro.334@m.kyushu-u.ac.jp
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Received: 19 September 2024 • Revised: 8 January 2025 • Accepted: 9 January 2025 |
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| Abstract |
Background
Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP.
Methods
This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP.
Results
The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence.
Conclusions
Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP. |
| Key Words:
Acute exacerbation; C-reactive protein; Fraction of inspired oxygen; Interstitial pneumonia; Mortality; Non-cardiac surgery |
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