Objective To evaluate the perioperative safety of lung surgery for patients with corona virus disease 2019 (COVID-19). Methods We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital. Patients who received lung surgery and without COVID-19 at the same time were selected as a control group. Perioperative data between the two groups were compared. Results A total of 103 patients were included with 44 males and 49 females at an average age of (62.2±12.1) years. All surgeries were performed by uniportal video-assisted thoracoscopic surgery (VATS). Among patients who recovered from COVID-19, 53 (51.5%) received lobectomy, 30 (29.1%) received segmentectomy, and 20 (19.4%) received wedge resection. The interval between diagnosis of infection and lung surgery was ≤1 month in 32 (31.1%) patients, and >1 month in 71 (68.9%) patients. The results of virus nucleic acid test for all patients before surgery were negative. A total of 13 (12.6%) patients had positive IgM, and 100 (97.1%) patients had positive IgG. A total of 20 patients experienced perioperative complications (13 patients with pulmonary air leakage, 3 patients with chylothorax, 2 patients with atrial fibrillation, and 2 patients with severe pulmonary complications). There was one perioperative death. Comparing the patients who recovered from COVID-19 with those without COVID-19, we found no statistical difference in perioperative outcomes including surgical duration, postoperative drainage, duration of thoracic tube, and duration of postoperative stay (P>0.05). There was no significant difference in perioperative complications between the two groups (P>0.05). Multivariable logistical regression analysis demonstrated that positive IgM before surgery (OR=7.319, 95%CI 1.669 to 32.103, P=0.008), and longer duration of surgery (OR=1.016, 95%CI 1.003 to 1.028, P=0.013) were independent risk factors of perioperative complications for patients who recovered from COVID-19. Conclusion It is safe for patients recover from COVID-19 to receive lung surgery when symptoms disappear and the nucleic acid test turn negative. However, positive COVID-19 IgM is an independent risk factor for perioperative complications. We suggest that lung surgery could be performed when the nucleic acid test and COVID-19 IgM are both negative for patients recover from COVID-19 infection.
Elderly patients with lung cancer have a significantly increased risk of perioperative cardiopulmonary complications due to physiological decline, high incidence of complications and reduced surgical tolerance, which directly affects postoperative recovery and long-term survival. Although the concepts of minimally invasive surgery and enhanced recovery after surgery have improved clinical outcomes, early recognition and intervention of postoperative complications in elderly patients remains a significant challenge in the field of thoracic surgery. By integrating recent literature and clinical practice, this paper systematically analyzes the pathophysiological mechanism and risk factors of perioperative cardiopulmonary complications in elderly patients with lung cancer, and discusses individualized intervention strategies based on risk stratification and multidisciplinary team, in order to provide theoretical basis and practical guidance for optimizing perioperative management and improving postoperative prognosis in elderly patients.
Objective To investigate the incidence and associated factors of postoperative cardiac complications in elderly patients with lung cancer. MethodsClinical data of elderly patients (age≥60 years) who underwent pulmonary resection for lung cancer at the Department of Thoracic Surgery, Beijing Hospital, from 2019 to 2022 were retrospectively analyzed. Based on the occurrence of cardiac complications (including arrhythmias, myocardial injury, and heart failure) between surgery and hospital discharge, the patients were divided into a complication group and a non-complication group. Univariate analysis was performed for the initial screening of variables. After addressing missing data using multiple imputation, a Firth’s bias-corrected multivariable logistic regression model was employed to identify independent associated factors for postoperative cardiac complications. Results There were 270 patients in the entire cohort, including 123 (45.6%) males and 147 (54.4%) females, with a median age of 71.0 (65.0, 77.0) years. The incidence of postoperative cardiac complications was 20.0% (54/270). Univariate analysis showed that age, pulmonary hypertension, pleural adhesion, and intraoperative blood transfusion were positively associated with postoperative cardiac complications, whereas body mass index (BMI) and a family history of cancer showed an inverse association (all P<0.05). Multivariable analysis further demonstrated that BMI was inversely associated with the incidence of postoperative cardiac complications [adjusted odds ratio (aOR)=0.868, 95%CI (0.778, 0.968), P=0.011], indicating that a lower BMI is an independent risk factor; pleural adhesion showed a positive association [aOR=2.130, 95%CI (1.104, 4.107), P=0.024]; and a family history of cancer exhibited an exploratory inverse association [aOR=0.249, 95%CI (0.068, 0.912), P=0.036]. ConclusionAmong elderly patients undergoing surgery for lung cancer, a lower BMI and the presence of pleural adhesion are independent risk factors for a higher incidence of postoperative cardiac complications, whereas a family history of cancer demonstrates an exploratory inverse association. In clinical practice, a comprehensive evaluation incorporating the patient's nutritional and functional reserves, as well as the extent of pleural adhesion, is recommended, alongside vigilant monitoring for early postoperative cardiac complications. The findings regarding a family history of cancer should be interpreted with caution, and all the above findings warrant further validation through large-scale, multicenter, prospective studies.