Pneumonectomy and Adverse Events After Discharge: Who is at Risk?

mainly based on the presence or absence of increased cardiac output. This difference may be responsible for adverse events occurring within a few months after surgery. The hypothesis of the study is that increased B-type natriuretic peptides (BNP) at discharge may identify a cohort of patients at higher risk of having early adverse events after pneumonectomy. Methods: After informed consent, the BNP from 40 consecutive patients undergoing pneumonectomy for lung cancer was assessed on the first postoperative day (POD1, baseline) and on POD5. They were divided into 2 groups, according to the differential BNP value: the study group (SG), composed of patients who had an increasing BNP value at POD5, and the control group, all of whom had stable or decreasing BNP. The main end-point of the study was the comparison of 90-day adverse events (death, cardiac and/or respiratory) between the 2 groups. Results: Out of the 40 patients who had an initial assessment of BNP, 2 postoperative deaths were recorded and 2 patients were not available for follow-up. The final follow-up population was therefore composed of 36 patients, ten of whom had an increasing BNP on POD5 (SG group, 27.7%). At 3 months, 3 adverse events (8.3%) were recorded in the SG group (sudden death, hospital readmission for acute respiratory failure, and chronic respiratory failure requiring oxygen in one patient, respectively). No event was recorded in the control group (p=0.05). Apart from increased BNP, no other clinical variable resulted as being significant as a predictor of adverse events at univariate analysis 90 days after discharge. Conclusions: Patients with increased BNP levels at discharge have an increased risk of adverse cardiorespiratory events during the first three postoperative months, therefore the possibility of reducing that risk through prolonged medical treatment should be considered.