Postoperative pulmonary embolism may be predictive of increased 30-day mortality, reintubation, and readmission rates in patients with lung cancer, according to recent findings presented by Axtell et al at The Society of Thoracic Surgeons (STS) Annual Meeting.
Background
Patients with lung cancer who undergo pulmonary resection are known to be at risk of postoperative complications such as venous thromboembolism—which can lead part of the clot to break off, lodge in the lung, and cause a pulmonary embolism.
Study Methods and Results
In this study, investigators used the STS’s General Thoracic Surgery Database—involving over 700,000 procedure records and more than 1,000 participating surgeons—to identify 57,531 patients who underwent pulmonary resection between January 2009 and June 2021. Among the patients, 2.5% developed postoperative venous thromboembolism. Further, 1.3% (n = 758) developed pulmonary embolism after their first pulmonary resection.
“Trends over time demonstrate the incidence of postoperative [venous thromboembolism] to be largely unchanged over the 12-year study period; however, the associated mortality rate slowly decreased from 20% in 2009 to 8% in 2018,” explained lead study author Andrea L. Axtell, MD, MPH, Assistant Professor of Surgery at the University of Wisconsin School of Medicine and Public Health.
The investigators found no differences in the risk of pulmonary embolism based on lung function prior to pulmonary resection, histology, or whether or not the patients received chemotherapy prior to surgery. Additionally, compared with patients of other races, Black patients were more likely to develop pulmonary embolism (12% vs 7%). The investigators also noted that those who had interstitial fibrosis, advanced-stage disease requiring bilobectomy or pneumonectomy, and increased operative duration had a heightened risk of developing postoperative pulmonary embolism.
“Black race has previously been identified as a predisposing factor for [venous thromboembolism] and was confirmed in our analysis,” Dr. Axtell stated.
Previous research by the U.S. Centers for Disease Control and Prevention discovered that Black individuals may have a 40% higher incidence of venous thromboembolism overall compared with White individuals as well as a 2.8-fold higher risk of venous thromboembolism in patients with lung cancer specifically.
“While this difference is likely multifactorial, previous investigations have suggested genetic variability, socioeconomic factors, and health disparities in access to high-volume, subspecialized care,” Dr. Axtell underscored.
Conclusions
These findings indicate that patients at increased risk of developing embolism after pulmonary resection may need to undergo additional imaging such as ultrasound of the legs or extended courses of blood-thinning medications to prevent the occurrence of clot formation.
“By increasing awareness of the increased risk for [venous thromboembolism] in Black patients, the team hopes to encourage more focused preventative measures in these patients. Because the predominating risk factors for postoperative [venous thromboembolism] identified in this analysis are nonmodifiable, and because [venous thromboembolism]–associated mortality is increased, enhanced awareness and targeted perioperative prophylactic measures should be considered in these high-risk cohorts,” Dr. Axtell concluded.
Disclosure: For full disclosures of the study authors, visit sts2024.eventscribe.net.
