Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection

• Published in: General thoracic and cardiovascular surgery 2021-03, Vol.69 (3), p.478-486
• Main Authors: Watanabe, Yukio, Hattori, Aritoshi, Fukui, Mariko, Matsunaga, Takeshi, Takamochi, Kazuya, Oh, Shiaki, Suzuki, Kenji
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; Anticoagulants; Body mass index; Calcification; Cardiac function; Cardiac Surgery; Cardiology; Catheters; Diabetes; Diabetic nephropathy; Electrolytes; Hemodialysis; Humans; Hypertension; Kidney diseases; Lung - diagnostic imaging; Lung - surgery; Lung cancer; Lung diseases; Lung Neoplasms - surgery; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Mortality; Original Article; Ostomy; Patients; Pneumonectomy - adverse effects; Postoperative Complications - etiology; Postoperative Complications - therapy; Potassium; Pulmonary arteries; Regression analysis; Renal Dialysis; Retrospective Studies; Risk Factors; Stroke; Surgical Oncology; Thoracic Surgery; Variables
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01489-x

Objectives The rate of lung resection in patients on hemodialysis (HD) is increasing with the increasing number of HD. However, studies assessing lung resection in HD are limited. The study aimed to investigate the perioperative management and postoperative complications of lung resection in HD patients. Methods Between 2007 and 2019, of the 4989 patients underwent lung resection, 43 patients had been receiving HD. We compared the characteristics of a Clavien–Dindo classification grade ≥ 2 group against grade ≤ 1 group. Predictive factors of complications were analyzed by logistic regression analysis. Results Thirty-three patients were men (median age: 69 years). Thirty-eight patients had lung cancer. The reason for HD was diabetic nephropathy in 19 patients, nephrosclerosis in 10, and miscellaneous in 14. The median duration of HD before surgery was 64.6 months. The type of lung resection was lobectomy in 24, segmentectomy in 10, and partial resection in 9 patients. Bronchial calcification was detected in 16 (37%). Reinforcement at the stump was performed in 9 lobectomies, of which 6 involved bronchial calcification. Postoperative complications were detected in 21 (49%), including grade ≥ 2 complications in 14 (33%). Multivariate analysis revealed that pack-year smoking ≥ 10 ( p  = 0.01) and operation time ≥ 140 min ( p  = 0.02) were predictors of grade ≥ 2 morbidity. Conclusions Heavy smoking and longer operative time may result in postoperative complication requiring therapeutic intervention. The frequency of bronchial calcification is relatively high in HD patients, and reinforcement of the calcified bronchial stump should be considered during lobectomy.