PROSPECTIVE ANALYSIS OF PNEUMONECTOMY - RISK-FACTORS FOR MAJOR MORBIDITY AND CARDIAC DYSRHYTHMIAS

Background. Data were acquired prospectively on 136 consecutive patien ts undergoing pneumonectomy for cancer from 1988 to 1993, to define fa ctors that increase the risk of major morbidity and postoperative card iac dysrhythmias. Methods. There were 81 patients (60%) with non-small cell lung cancer (standard pneumonectomy) and 55 patients (40%) with malignant pleural mesothelioma (extrapleural pneumonectomy). Results. Four perioperative deaths occurred 13%) with no identifiable associate d risk factors. Twenty-three patients (17%) had a major complication w ith an increase in the median length of stay from 7 to 11 days (p < 0. 01). Age greater than 65 years, right-sided procedures, and dysrhythmi as were associated with an increased risk of a major complication (p < 0.05). Thirty-two patients (24%) had supraventricular dysrhythmias, w hich occurred on postoperative days 1 to 2 (n = 8), 3 to 4 (n = 13), 5 to 6 (n = 6), and 7 to 12 (n = 5). The median length of stay increase d from 8 to 11 days with dysrhythmias (p < 0.05). Factors associated w ith an increased risk of dysrhythmias (p < 0.05) included age greater than 65 years, intrapericardial or extrapleural pneumonectomy, right-s ided procedure, and any major complication. Conclusions. Pneumonectomy can be performed safely in selected patients with cancer. Supraventri cular dysrhythmia was the most common complication noted with a peak i ncidence at 3 to 4 days after resection.