Risk Factors for Postoperative Complications after Pneumonectomy in Non-Small Cell Lung Cancer Patients

Objectives: The impact of preoperative predisposing factors on postoperative complications in patients undergoing pneumonectomy for non-small cell lung cancer (NSCLC) remains a critical issue. Understanding these factors may provide valuable insights into postoperative risks and complications. This study aimed to evaluate the influence of preoperative predisposing factors (comorbidities) on the development of postoperative complications in patients undergoing pneumonectomy for NSCLC. Using the age-adjusted Charlson Comorbidity Index (a-CCI), we sought to identify risk factors that potentially contribute to complications and investigate their impact on survival.
Methods: In this retrospective study, 236 patients who underwent pneumonectomy between February 2018 and February 2023 were analyzed. Demographic characteristics, comorbidities based on the a-CCI, surgical details, postoperative complications classified according to the Clavien–Dindo system, and survival outcomes were evaluated.
Result: Postoperative complications occurred in 44.1% of patients (n=104). The development of complications was significantly associated with right-sided pneumonectomy (p=0.018), prolonged operative time (p=0.002), and increased intraoperative blood loss (p<0.001). Although the a-CCI failed to predict postoperative complications, it demonstrated a significant association with survival outcomes. Patients with higher a-CCI scores had markedly reduced mean survival times (p=0.001).
Conclusion: In patients undergoing pneumonectomy for NSCLC, right-sided resections, prolonged operative duration, and exces-sive intraoperative blood loss increase the risk of postoperative complications. While the a-CCI is limited in predicting postoperative complications, it serves as a valuable prognostic indicator of survival. Assessing these factors may guide risk stratification and optimize perioperative management strategies in surgical candidates.

Keywords: Charlson comorbidity index, clavien–dindo classification, non-small cell lung cancer, pneumonectomy, postoperative complications, survival analysis