Incidence of Stroke After Pneumonectomy and Lobectomy

  • Signe Riddersholm
    From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
  • Bhupendar Tayal
    From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
  • Kristian Kragholm
    From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
  • Jan Jesper Andreasen
    Department of Cardiothoracic Surgery (J.J.A.), Aalborg University Hospital, Denmark
  • Bodil Steen Rasmussen
    Department of Anaesthesiology and Intensive Care Medicine (S. Riddersholm, B.S.R.), Aalborg University Hospital, Denmark
  • Peter Søgaard
    From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
  • Christian Torp-Pedersen
    Unit of Epidemiology and Biostatistics (C.T.-P.), Aalborg University Hospital, Denmark
  • Sam Riahi
    From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark

書誌事項

タイトル別名
  • A Nationwide, Register-Based Study

抄録

<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95% CI, 2.04–7.12) and 5.43 (95% CI, 3.99–7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95% CI, 1.39–6.25) and for patients without atrial fibrillation (IRR, 2.56; 95% CI, 1.86–3.59).When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95% CI, 1.19–5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95% CI, 0.72–12.29).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.</jats:p> </jats:sec>

収録刊行物

  • Stroke

    Stroke 50 (5), 1052-1059, 2019-05

    Ovid Technologies (Wolters Kluwer Health)

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