Postoperative outcomes of frequent exacerbator patients with Chronic Obstructive Pulmonary Disease after resection of Non-Small Cells Lung Cancer

Figures & data

Figure 1. Flow chart.

COPD, Chronic obstructive pulmonary disease; FE, Frequent exacerbator.

Table 1. Demographic data.

	All n = 93	FE n = 21	Non-FE n = 72	p
Age (years)	68 (60–72)	67 (58–71)	68 (61–72)	0.62
Men	64 (68%)	14 (67%)	50 (69%)	0.55
BMI (kg.m^−2)	24 (21–27)	27 (25–29)	24 (22–27)	0.02
Charlson Score	4 (3–4)	4 (3–4)	4 (3–4)	0.81
ASA Score ≥3	54 (58%)	17 (81%)	37 (51%)	0.016
ECOG performans status	1 (1–2)	2 (1–2)	1 (1–2)	0.3
Thoracoscore	3.52 (1.97–4.69)	3.52 (2.8–4.7)	3.52 (1.79–4.49)	0.25
Cardio-vascular disease	21 (22%)	5 (24%)	16 (22%)	0.7
Heart failure	10 (11%)	2 (10%)	8 (11%)	0.8
Arythmia	8 (9%)	2 (10%)	6 (8%)	0.86
Coronary disease	14 (15%)	3 (14%)	11 (15%)	0.9
Arteritis obliterans	16 (17%)	2 (10%)	13 (18%)	0.32
Apnea syndrome	9 (10%)	5 (24%)	4 (6%)	0.013
Chronic kidney injury	7 (7%)	1 (5%)	6 (8%)	0.59
Corticoids (n = 65)	3 (5%)	0 (0%)	3 (5%)	0.34
Diabetes	13 (14%)	1 (5%)	12 (17%)	0.16
Chronic ethylism	15 (16%)	2 (10%)	13 (18%)	0.35
Pulmonary artery hypertension	5 (5%)	1 (5%)	4 (6%)	0.9
HAD score
Anxiety	7 (4–10)	9 (4–12)	7 (4–10)	0.22
Depression	4 (2–8)	6 (3–9)	4 (1–7)	0.15
Cancer type				0.42
Adenocarcinoma	53 (56%)	10 (48%)	43 (60%)
Epidermoid carcinoma	29 (31%)	9 (42%)	20 (28%)
Other	12 (13%)	2 (10%)	9 (12%)
Tumor stage				0.7
I	54 (57%)	11 (52%)	43 (60%)
II	15 (15%)	5(24%)	10 (14%)
III	22 (23%)	5 (24%)	17 (23%)

COPD, chronic obstructive pulmonary disease; FE, frequent exacerbator; BMI, body mass index. ASA, American society of anesthesiology. Data are presented as median (interquartile range 25–75%) or number and percentages.

Table 2. Respiratory characteristics.

	All n = 93	FE n = 21	Non-FE n = 72	p
COPD knowledge	37 (39%)	10 (48%)	27 (38%)	0.17
Medical consultation for exacerbation during the last 12 months	1 (0–2)	3 (2–3)	1 (0–2)	0.0001
Hospitalizations for exacerbations during the last 12 months	0 (0–0)	0 (0–1)	0 (0–0)	0.048
Smoking history	91 (97%)	29 (95%)	71 (99%)	0.34
BODE score	2 (1–2)	2 (2–3)	1 (1–2)	0.007
MRC	1 (0–1)	1 (1–1)	1 (0–1)	0.12
CAT	12 (7–17)	15 (12–17)	9 (7–16)	0.02
IPAQ	2 (1–3)	1 (1–3)	2 (1–3)	0.09
FEV1 (% predicted)	72 (61–80)	70 (59–80)	72 (61–82)	0.51
% FVC	88 (74–99)	81 (74–95)	90 (76–100)	0.29
% DLCO	61 (48–74)	62 (48–75)	60 (49–74)	0.91
Predicted post-operative FEV1 (% predicted)	53 (46–63)	53 (44–64)	54 (47–63)	0.66
% Total lung capacity	110 (95–115)	113 (97–95)	109 (96–121)	0.58
GOLD 2011				0.62
I	23 (23%)	4 (19%)	19 (26%)
II	61 (61%)	14 (67%)	47 (65%)
III	9 (10%)	3 (14%)	6 (8%)
IV	0 (0%)	0 (0%)	0 (0%)
GOLD 2013				<0.0001
A	34 (36%)	0 (0%)	34 (47%)
B	16 (17%)	0 (0%)	15 (21%)
C	16 (17%)	6 (29%)	11 (15%)
D	27 (29%)	15 (71%)	12 (17%)

COPD, chronic obstructive pulmonary disease; FE, frequent exacerbator; BODE, body mass index, airflow obstruction, functional dyspnea, exercise capacity. MRC, medical research council; CAT, COPD assessment test; IPAQ, International Physical Activity Questionnaire; FEV1 , forced expiratory volume in 1 second. FVC, forced vital capacity. GOLD, Global Initiative for Chronic Obstructive Lung Disease. Data are presented as median (interquartile range 25–75%) or number and percentages.

Table 3. Interventional data.

	All n = 93	FE n = 21	Non FE n= 72	p
Duration of intervention (hours)	3.5 (3–4.5)	4 (3.5–4.5)	3.5 (3–4.5)	0.35
Type of surgery				0.85
Pneumonectomy	12 (13%)	3 (14%)	9 (13%)
Bi-lobectomy	4 (4%)	0 (0%)	4 (6%)
Lobectomy	53 (57%)	12 (57%)	41 (57%)
Segmentectomy	7 (8%)	4 (19%)	13 (18%)
Wedge	17 (18%)	2 (10%)	5 (7%)
Ventilatory complications	42 (45%)	14 (67%)	28 (39%)	0.02
Bipulmonary ventilation	12 (13%)	6 (29%)	6 (8%)	0.015
CPAP	6 (6%)	2 (10%)	4 (6%)	0.52
Oxygen (Fi) 100%	28 (30%)	11 (52%)	17 (24%)	0.011
Analgesia
Thoracic peridural	6 (6%)	2 (10%)	4 (6%)	0.51
Paravertebral block	82 (88%)	19 (90%)	63 (88%)	0.71

CPAP, Continous positive airway pressure. Data are presented as median (interquartile range 25–75%) or number and percentages.

Table 4. Respiratory complications.

	All n = 93	FE n = 21	Non-FE n = 72	p
Patients with at least one complication	55 (59%)	16 (76%)	38 (54%)	0.056
Post operative pneumonia	24 (26%)	9 (43%)	15(21%)	0.042
Pururlent tracheobronchitis	44 (47%)	14 (67%)	30 (42%)	0.043
Atelectasis	45 (48%)	13 (62%)	32 (44%)	0.16
Acute respiratory failure	35 (37%)	11 (52%)	24 (33%)	0.11
Overall respiratory complications	148	47	101	0.00058
Therapeutic non invasive ventilation (NIV)	22 (23%)	9 (43%)	13 (18%)	0.019
Hypercapnia	12 (13%)	6 (29%)	6 (8%)	0.015
Hypoxemia	12 (13%)	4 (19%)	8 (11%)	0.34
Invasive ventilation	4 (4%)	1 (5%)	3 (4%)	0.9

Table 5. Outcome after ICU admission complications.

	All n = 93	FE n = 21	Non-FE n = 72	p
Admitted 3in IC	60 (64%)	15 (71%)	45 (63%)	0.09
SAPS 2	17 [12–21]	17 [12–18]	16 [13–21]	0.86
Infection of the surgical site	2 (2%)	0 (0%)	2 (3%)	0.44
Chest drainage duration	3 [3–4]	3 [3–4]	3 [3–4]	0.71
Acute kidney injury	14 (15%)	4 (19%)	10 (14%)	0.73
Cardio- vascular complications	21 (22%)	2 (10%)	19 (26%)	0.09
Sepsis	15 (16%)	3 (14%)	12 (17%)	0.78
Hospital stay (days)	9 [8–14]	11 [9–19]	9 [8–12]	0.27

FE, frequent exacerbator; SAPS II, simplified acute physiological score II.

Table 6. Comparaison between patients presenting or not post operative pulmonary complications.

	Pulmonary complication n = 55	No pulmonary complication n = 38	p
Age	68 (61–73)	67 (58–71)	0.16
Men	45 (82%)	19 (50%)	0.001
BMI	26 (23–31)	23 (21–26)	0.001
Charlson score	4 (3–5)	3 (3–4)	0.07
ASA score ≥3	3 (2–3)	2 (2–3)	0.03
ECOG performans status	1 (1–2)	1 (1–2)	0.12
Thoracoscore	4.1 (2.8–5.6)	2.4 (1.7–4.4)	0.006
Cardio vascular	7 (13%)	3 (8%)	0.47
Apnea syndrome	7 (13%)	2 (5%)	0.24
Chronic kidney injury	4 (7%)	3 (8%)	0.92
Diabetes	9 (16%)	4 (11%)	0.43
Chronic ethylism	11 (20%)	4 (11%)	0.22
Cancer type			0.15
Adenocarcinoma	28 (51%)	25 (66%)
Other	27 (49%)	13 (34%)
Tumor staging			0.72
I	31 (56%)	23 (42%)
II	10 (18%)	6 (11%)
III	14 (25%)	9 (16%)
FE phenotype	16 (29%)	5 (13%)	0.07
COPD knowledge	24 (44%)	13 (34%)	0.36
Medical consultation for exacerbation during the last 12 months	2 (0–2)	1 (0–2)	0.07
Hospitalizations for exacerbations during the last 12 patients	0 (0–1)	0 (0–0)	0.03
Smoking history	54 (98%)	37 (97%)	0.8
BODE score	2 (1–3)	1 (1–2)	0.08
MRC	1 (0–1)	1 (0–1)	0.88
CAT	13 (7–17)	10 (6–15)	0.6
IPAQ	2 (1–3)	2 (1–2)	0.36
FEV1/FVC	60 (54–65)	62 (56–67)	0.32
FVC	82 (74–97)	92 (82- 105)	0.044
FEV1	69 (59- 78)	73 (67–82)	0.13
DLCO	62 (57–74)	56 (45–70)	0.94
GOLD 2013			0.16
A	19 (35%)	14 (37%)
B	7 (13%)	7 (18%)
C	9 (16%)	7 (18%)
D	20 (36%)	5 (13%)
Prolonged Fi oxygen 100% during surgery	22 (40%)	6 (16%)	0.012
Noninvasive ventilation	26 (47%)	3 (8%)	0.9
Invasive ventilation	4 (0.7%)	0 (0%)	0.09
Admitted to ICU	42 (76%)	18 (47%)	0.004
Hospital stay	12 (9–19)	8 (7–10)	0.8
30-day mortality	0	0
90-day mortality	2 (4%)	2 (5%)	0.69

BMI, body mass index; FE, frequent exacerbator; BODE, body mass index, airflow obstruction, functional dyspnoea, exercise capacity; MRC, medical research council; CAT, COPD assessment test; IPAQ, International Physical Activity Questionnaire; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, global initiative for chronic obstructive lung disease; ICU, intensive care unit. Data are presented as median (interquartile range 25–75%) or number and percentages.

Table 7. Final results of stepwise multivariate logistic regression for risk factors of post operative pulmonary complications.

	p	RR (95% CI)
Male sex	0.006	OR 10.6 (1.97–57.6)
FE phenotype	0.045	OR 6.33 (1.04–38.39)

We entered in the model the following factors associated with postoperative complications with a p value <0.1 at univariate analysis (Table 6): sex; BMI; FVC; DLCO/AV, Thoracoscore, prolonged FiO₂ during surgery, frequent exacerbator (FE) Fenotype.