TY - JOUR
T1 - Preoperative Thoracic CT Findings Associated With Postoperative Mechanical Ventilation in Patients Undergoing Major Abdominal or Pelvic Surgery
T2 - A Matched Case-Control Study
AU - Canan, Arzu
AU - Kandathil, Asha
AU - Li, Jing Lei
AU - Xi, Yin
AU - Wehrmann, Lauren
AU - Bryson, Trenton
AU - Browning, Travis
AU - Abbara, Suhny
AU - Fox, Amanda A.
N1 - Publisher Copyright:
© 2022 American Roentgen Ray Society. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND. Postoperative prolonged mechanical ventilation is associated with increased morbidity and mortality. Reliable predictors of the need for postoperative mechanical ventilation after abdominal or pelvic surgeries are lacking. OBJECTIVE. The purpose of this study was to explore associations between preoperative thoracic CT findings and the need for postoperative mechanical ventilation after major abdominal or pelvic surgeries. METHODS. This retrospective case-control study included patients who underwent abdominal or pelvic surgeries during the period from January 1, 2014, through December 31, 2018, and had undergone preoperative thoracic CT. Case patients were patients who required postoperative mechanical ventilation. Control patients and case patients were matched at a 3:1 ratio on the basis of age, sex, body mass index, chronic obstructive pulmonary disease, smoking status, and surgery type. Two radiologists (readers 1 and 2) reviewed the CT images. Findings were compared between groups. RESULTS. The study included 165 patients (70 women, 95 men; mean age, 67.0 ±9.7 [SD] years; 42 case patients and 123 matched control patients). Bronchial wall thickening and pericardial effusion were more frequent in case patients than control patients for reader 2 (10% vs 2%, p = .03; 17% vs 5%, p = .01) but not for reader 1. Pulmonary artery diameter (mean ±SD) was greater in case patients than control patients for reader 2 (2.9 ± 0.5 cm vs 2.8 ±0.5 cm, p = .045) but not reader 1. Right lung height was lower in case patients than control patients for reader 1 (18.4 ±2.9 cm vs 19.9 ±2.7 cm, p = .01) and reader 2 (18.3 ±2.9 cm vs 19.8 ±2.7 cm, p = .01). Left lung height was lower in case patients than control patients for reader 1 (19.5 ±3.1 cm vs 21.1 ±2.6 cm, p = .01) and reader 2 (19.6 ±2.4 cm vs 20.9 ±2.6 cm, p = .01). Anteroposterior (AP) chest diameter was greater for case patients than control patients for reader 1 (14.0 ±2.3 cm vs 12.9 ±3.7 cm, p = .02) and reader 2 (14.2 ±2.2 cm vs 13.2 ±3.6 cm, p = .04). In a multivariable regression model using pooled reader data, bronchial wall thickening exhibited an odds ratio (OR) of 4.6 (95% CI, 1.3-16.5; p = .02); pericardial effusion, an OR of 5.1 (95% CI, 1.7-15.5; p = .004); pulmonary artery diameter, an OR of 1.4 per 1-cm increase (95% CI, 0.7-3.0; p = .32); mean lung height, an OR of 0.8 per 1-cm increase (95% CI, 0.7-1.001; p = .05); and AP chest diameter, an OR of 1.2 per 1-cm increase (95% CI, 1.013-1.4; p = .03). CONCLUSION. CT features are associated with the need for postoperative mechanical ventilation after abdominal or pelvic surgery.
AB - BACKGROUND. Postoperative prolonged mechanical ventilation is associated with increased morbidity and mortality. Reliable predictors of the need for postoperative mechanical ventilation after abdominal or pelvic surgeries are lacking. OBJECTIVE. The purpose of this study was to explore associations between preoperative thoracic CT findings and the need for postoperative mechanical ventilation after major abdominal or pelvic surgeries. METHODS. This retrospective case-control study included patients who underwent abdominal or pelvic surgeries during the period from January 1, 2014, through December 31, 2018, and had undergone preoperative thoracic CT. Case patients were patients who required postoperative mechanical ventilation. Control patients and case patients were matched at a 3:1 ratio on the basis of age, sex, body mass index, chronic obstructive pulmonary disease, smoking status, and surgery type. Two radiologists (readers 1 and 2) reviewed the CT images. Findings were compared between groups. RESULTS. The study included 165 patients (70 women, 95 men; mean age, 67.0 ±9.7 [SD] years; 42 case patients and 123 matched control patients). Bronchial wall thickening and pericardial effusion were more frequent in case patients than control patients for reader 2 (10% vs 2%, p = .03; 17% vs 5%, p = .01) but not for reader 1. Pulmonary artery diameter (mean ±SD) was greater in case patients than control patients for reader 2 (2.9 ± 0.5 cm vs 2.8 ±0.5 cm, p = .045) but not reader 1. Right lung height was lower in case patients than control patients for reader 1 (18.4 ±2.9 cm vs 19.9 ±2.7 cm, p = .01) and reader 2 (18.3 ±2.9 cm vs 19.8 ±2.7 cm, p = .01). Left lung height was lower in case patients than control patients for reader 1 (19.5 ±3.1 cm vs 21.1 ±2.6 cm, p = .01) and reader 2 (19.6 ±2.4 cm vs 20.9 ±2.6 cm, p = .01). Anteroposterior (AP) chest diameter was greater for case patients than control patients for reader 1 (14.0 ±2.3 cm vs 12.9 ±3.7 cm, p = .02) and reader 2 (14.2 ±2.2 cm vs 13.2 ±3.6 cm, p = .04). In a multivariable regression model using pooled reader data, bronchial wall thickening exhibited an odds ratio (OR) of 4.6 (95% CI, 1.3-16.5; p = .02); pericardial effusion, an OR of 5.1 (95% CI, 1.7-15.5; p = .004); pulmonary artery diameter, an OR of 1.4 per 1-cm increase (95% CI, 0.7-3.0; p = .32); mean lung height, an OR of 0.8 per 1-cm increase (95% CI, 0.7-1.001; p = .05); and AP chest diameter, an OR of 1.2 per 1-cm increase (95% CI, 1.013-1.4; p = .03). CONCLUSION. CT features are associated with the need for postoperative mechanical ventilation after abdominal or pelvic surgery.
KW - CT
KW - Postoperative mechanical ventilation
KW - Surgery
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U2 - 10.2214/AJR.21.26411
DO - 10.2214/AJR.21.26411
M3 - Article
C2 - 34467781
AN - SCOPUS:85123813226
SN - 0361-803X
VL - 218
SP - 279
EP - 289
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 2
ER -