The following is a summary of “Surgical outcomes and perioperative risk factors of patients with interstitial lung disease after pulmonary resection,” published in the February 2024 issue of Surgery by Huang et al.

The prevalence of interstitial lung disease (ILD) alongside pulmonary lesions presents a growing challenge in clinical settings, with patients facing elevated risks of complications following pulmonary resection, notably acute exacerbations of ILD (AE-ILD). This study aims to delineate the short- and long-term outcomes of post-pulmonary resection in ILD patients and analyze the clinical determinants influencing surgical safety.

Between January 2004 and January 2022, 78 ILD-diagnosed patients undergoing pulmonary resection at the institution were retrospectively enrolled. Clinical data, pathological findings, surgical techniques, and intraoperative safety were collected. Researchers assessed 90-day postoperative complications and mortality, long-term outcomes spanning 90 days to 24 months post-surgery, and ILD progression. Logistic regression analysis identified risk factors for postoperative complications.

The median age was 66.5 years (range: 33–86), with 82.1% male and 78.2% presenting comorbidities. Idiopathic ILD and secondary ILD accounted for 86% and 14%, respectively, with thoracotomy and video-assisted thoracoscopic surgery (VATS) comprising 12.8% and 87.2%, and lobectomy and sublobar resection at 37.2% and 62.8%. Postoperative 90-day complications occurred in 25.6% of patients, with pulmonary complications and AE-ILD in 15.4% and 9.0%, respectively. The 90-day mortality rate was 5.1%, primarily due to AE-ILD. From 90 days to 24 months post-surgery, 12.8% experienced ILD exacerbation or complications. Univariate analysis identified comorbidity burden, resection extent, lymph node dissection, operation time, intraoperative blood loss, and pulmonary lesion pathology as associated with 90-day postoperative complications. Multivariate analysis revealed age-adjusted Charlson Comorbidity Index and intraoperative blood loss as independent risk factors.

Patients with ILD exhibit significantly heightened risks of 90-day postoperative complications and mortality, especially pulmonary complications and AE-ILD. Beyond 90 days, ongoing deterioration risk persists, encompassing ILD exacerbations and long-term glucocorticoid and immunosuppressant-related complications. Age, comorbidities, and intraoperative blood loss emerge as notable predictors of postoperative complications.

 Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-02508-1