Bronchoscopy increased the risk of postoperative pulmonary complications in patients undergoing lobectomy for lung cancer: a retrospective cohort study

Abstract

Background: Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and mortality, particularly following thoracic surgeries like lobectomy for lung cancer. These complications not only increase patient suffering but also lead to longer hospital stays and higher healthcare costs. Bronchoscopy, a procedure that enables airway visualization, serves both diagnostic and therapeutic functions. In postoperative care, bronchoscopy helps clear secretions, identify and resolve airway issues, and assess lung re-expansion. This study aimed to investigate whether patients admitted to the intensive care unit (ICU) with routine treatment with bronchoscopy after lobectomy for lung cancer can reduce PPCs, shorten the length of hospital stay, and reduce hospitalization expenses.

Methods: This study was a single-center, retrospective cohort study of patients who underwent lobectomy for lung cancer and were subsequently admitted to the ICU between January and December 2021. PPCs, length of hospital stay, and hospitalization expenses were compared between patients treated with bronchoscopy (the bronchoscopy group) and without bronchoscopy (the non-bronchoscopy group). Additionally, the risk factors of postoperative pulmonary complications were analyzed.

Results: A total of 515 patients were included, with 179 patients in the bronchoscopy group and 336 patients in the non-bronchoscopy group. Patients in the bronchoscopy group experienced a higher incidence of PPCs [73 (40.8%) vs. 57 (17.0%); P<0.001], prolonged length of hospital stay [median (interquartile range): 11 (7-14) vs. 7 (5-9.8) days; P<0.001], and higher hospitalization expenses [median (interquartile range): 58,392 (51,248-64,998) vs. 53,563 (48,580-59,276) yuan; P<0.001] than patients in the non-bronchoscopy group. As shown by multifactor logistic regression analysis, postoperative bronchoscopy and tumor size were associated with increased risk of PPCs [odds ratio (OR) 2.71, 95% confidence interval (CI): 1.74-4.21, P<0.001; OR 1.20, 95% CI: 1.05-1.36, P=0.006, respectively], while video-assisted thoracoscopic surgery was associated with a decreased risk (OR 0.22, 95% CI: 0.11-0.45, P<0.001).

Conclusions: Bronchoscopy was associated with a higher risk of PPCs as well as with prolonged hospital stays and increased hospital expenses among postoperative patients who underwent lobectomy for lung cancer. It should be cautiously considered in clinical practice.

Keywords: Bronchoscopy; lobectomy; postoperative pulmonary complications (PPCs).

Figure 1

Patient enrollment process.