Preoperative Risk Stratification and Multidisciplinary Team Approach for Major Lung Resection: Strategies to Minimize Preoperative and Postoperative Complications

Abstract

Background

The lung resections (lobectomy and pneumonectomy) are necessary interventions in case of lung diseases, particularly lung cancer. These are procedures that are linked to great risks, so a multidisciplinary team approach, plus a thorough preoperative evaluation of the risks, can help reduce complications. The effectiveness of these strategies is assessed in this prospective study in 100 patients who have major lung resections.

Objectives

To assess the effects of pretreatment risk stratification and a multidisciplinary team approach on postoperative complications reduction and general outcome improvement in patients undergoing major lung resections.

Methodology

This was a prospective study Conducted at department of Cardiothoracic Anesthesia Lady Reading Hospital MTI Peshawar Pakistan from jan 2020 to june 2020. 100 patients who were to undergo major lung resection, lobectomy, and pneumonectomy. Pulmonary function testing, a cardiovascular evaluation, and a frailty scoring were included in the preoperative risk assessment. Surgeons, pulmonologists, anesthesiologists, cardiologists, and nutritionists were the multidisciplinary team who cooperated to maximize care. The most important outcomes were the occurrence of postoperative complications, which included respiratory failure, infections, and arrhythmias. Two of the secondary outcomes were the length of hospital stay and survival. The SPSS software was used to conduct the statistical analysis, with the significance level being p<0.05.

Results
A total of 100 patients (mean age 65.3 years, SD = 9.2) underwent major lung resections (70 lobectomies, 30 pneumonectomies). Common comorbidities included hypertension (45%), COPD (40%), and diabetes (30%). The multidisciplinary approach reduced complications significantly: respiratory complications occurred in 12% of patients (vs. 28% in controls, p=0.02), and cardiovascular complications (e.g., atrial fibrillation) were seen in 7%. The mean hospital stay was 6.8 days (SD = 2.8), significantly shorter than the historical average of 9.4 days (p=0.01). The 1-year mortality rate was 6%, with an overall survival rate of 82%.

Conclusion

The study indicates that risk stratification in the preoperative setting and a multidisciplinary practice can contribute a lot to the reduction of postoperative complications and recovery of patients undergoing major lung resections. The focus on optimization of pulmonary and cardiovascular functioning and management of comorbidities plays a crucial role in improving the outcomes of postoperative care, shortening the time of recovery, and improving survival.