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. 2024 Jun 10;10(12):e32821.
doi: 10.1016/j.heliyon.2024.e32821. eCollection 2024 Jun 30.

Incidence and risk factors of pulmonary complications after lung cancer surgery: A systematic review and meta-analysis

Ting Deng  1   2   3 , Jiamei Song  1   2 , Jinmei Tuo  1 , Yu Wang  1 , Jin Li  3 , Lorna Kwai Ping Suen  4 , Yan Liang  1   2 , Junliang Ma  3 , Shaolin Chen  1   2
Affiliations

Incidence and risk factors of pulmonary complications after lung cancer surgery: A systematic review and meta-analysis

Ting Deng et al. Heliyon. .

Abstract

Postoperative pulmonary complications (PPCs) are associated with high mortality rates after lung cancer surgery. Although some studies have discussed the different risk factors for PPCs, the relationship between these factors and their impact on PPCs remains unclear. Hence, this study aimed to systematically summarize the incidence and determine the risk factors for PPCs. We conducted a systematic search of five English and four Chinese databases from their inception to April 1, 2023. A total of 34 articles (8 cohort studies and 26 case-control studies) (n = 31696, 5833 with PPCs) were included in the analysis. The primary outcome was the incidence of PPC. The secondary outcome was the odds ratio (OR) of PPCs based on the identified risk factors calculated by RevMan 5.4. A narrative descriptive summary of the study results was presented when pooling the results or conducting a meta-analysis was not possible. The pooled incidence of PPCs was 18.4 %. This meta-analysis demonstrated that TNM staging (OR 4.29, 95 % CI 2.59-7.13), chronic obstructive pulmonary disease (COPD) (OR 2.47, 95 % CI 1.80-3.40), smoking history (OR 2.37, 95 % CI 1.33-4.21), poor compliance with respiratory rehabilitation (OR 1.64, 95 % CI 1.17-2.30), male sex (OR 1.62, 95 % CI 1.28-2.04), diabetes (OR 1.56, 95 % CI 1.07-2.27), intraoperative bleeding volume (OR 1.44, 95 % CI 1.02-2.04), Eastern Cooperative Oncology Group score (ECOG) > 1 (OR 1.37, 95 % CI 1.04-1.80), history of chemotherapy and/or radiotherapy (OR 1.32, 95 % CI 1.03-1.70), older age (OR 1.18, 95 % CI 1.11-1.24), and duration of surgery (OR 1.07, 95 % CI 1.04-1.10) were significantly associated with a higher risk of PPCs. In contrast, the peak expiratory flow rate (PEF) (OR 0.99, 95 % CI 0.98-0.99) was a protective factor. Clinicians should implement targeted and effective interventions to prevent the occurrence of PPCs.

Keywords: Lung cancer; Meta-analysis; Postoperative pulmonary complications; Risk factors; Systematic review; Thoracic surgery.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for identification of inclusion studies.
Fig. 2
Fig. 2
Forest plot of age as a risk factor for postoperative pulmonary complications (PPCs) after lung cancer surgery.
Fig. 3
Fig. 3
Forest plot of estimated risk factors of postoperative pulmonary complications (PPCs) after lung cancer surgery associated with sex.
Fig. 4
Fig. 4
Forest plot of the estimated risk factor of postoperative pulmonary complications (PPCs) after lung cancer surgery associated with a smoking history.
Fig. 5
Fig. 5
Forest plot of the estimated risk factor of postoperative pulmonary complications (PPCs) after lung cancer surgery associated with chronic obstructive pulmonary disease (COPD).
Fig. 6
Fig. 6
Forest plot of the history of chemotherapy and/or radiotherapy and the risk of postoperative pulmonary complications (PPCs) after lung cancer surgery subgroup analysis.
See this image and copyright information in PMC

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