{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:40:08Z","timestamp":1789800008853,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing open thoracotomy lung resection (OTLR) for reasons other than primary lung cancer. Methods: Data from this multicenter, retrospective study involving 1.368 patients were extracted from the German Thorax Registry and analyzed using univariate and multivariable statistical methods. Results: In total, 278 patients showed at least one PPC. The presence of PPCs was associated with a significantly higher in-hospital mortality rate (7.2% vs. 1.5%; p = 0.000). Multivariable stepwise logistic regression analysis showed absolute age (OR 1.02) and BMI \u2264 19 (OR 2.6) as independent patient-specific risk factors. Significant preoperative risk factors included re-thoracotomy (OR 4.0) and FEV1 &lt; 60% (OR 2.5). Procedure-related independent risk factors for PPCs included a surgical duration surpassing 195 min (OR 2.7), the continuation of invasive ventilation post-surgery (OR 3.8), and an intraoperative infusion of crystalloids greater than 6 mL\/kg\/h (OR 1.8). Conclusions: Optimizing intraoperative fluid therapy and on-table extubation when possible may reduce the incidence of PPCs and associated mortality.<\/jats:p>","DOI":"10.3390\/jcm14051565","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T06:15:33Z","timestamp":1740550533000},"page":"1565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Risk Factors for Postoperative Pulmonary Complications in Patients Undergoing Thoracotomy for Indications Other than Primary Lung Cancer Resection: A Multicenter Retrospective Cohort Study from the German Thorax Registry"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6639-2938","authenticated-orcid":false,"given":"Wolfgang","family":"Baar","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8811-5755","authenticated-orcid":false,"given":"Axel","family":"Semmelmann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Anselm","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Loop","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2942-0351","authenticated-orcid":false,"given":"Sebastian","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Working Group of the German Thorax Registry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S1040-8428(97)00017-6","article-title":"Lung Metastasectomy: Why, When, How","volume":"26","author":"Pastorino","year":"1997","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1097\/JTO.0b013e3182208e58","article-title":"A 10-Year Single-Center Experience on 708 Lung Metastasectomies: The Evidence of the \u201cInternational Registry of Lung Metastases\u201d","volume":"6","author":"Casiraghi","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/s11748-015-0544-9","article-title":"Pulmonary Metastasectomy: Outcomes and Issues According to the Type of Surgical Resection","volume":"63","author":"Higashiyama","year":"2015","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1111\/anae.14649","article-title":"Association between Anaesthetic Technique and Unplanned Admission to Intensive Care after Thoracic Lung Resection Surgery: The Second Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) National Audit","volume":"74","author":"Shelley","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"LaPar, D.J., Bhamidipati, C.M., Lau, C.L., Jones, D.R., and Kozower, B.D. (2012). The Society of Thoracic Surgeons General Thoracic Surgery Database: Establishing Generalizability to National Lung Cancer Resection Outcomes. Ann. Thorac. Surg., 94.","DOI":"10.1016\/j.athoracsur.2012.03.054"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1111\/anae.15848","article-title":"Effect of Ventilation Mode on Postoperative Pulmonary Complications Following Lung Resection Surgery: A Randomised Controlled Trial","volume":"77","author":"Li","year":"2022","journal-title":"Anaesthesia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1053\/j.jvca.2023.04.017","article-title":"Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema","volume":"37","author":"Semmelmann","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Baar, W., Semmelmann, A., Knoerlein, J., Weber, F., Heinrich, S., Loop, T., and Working Group of the German Thorax Registry (2022). Risk Factors for Postoperative Pulmonary Complications Leading to Increased In-Hospital Mortality in Patients Undergoing Thoracotomy for Primary Lung Cancer Resection: A Multicentre Retrospective Cohort Study of the German Thorax Registry. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195774"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0003-4975(03)01601-1","article-title":"Salvage Intensive Care Following Initial Recovery from Pulmonary Resection: Is It Justified?","volume":"77","author":"Pilling","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/1749-8090-5-62","article-title":"Postresectional Lung Injury in Thoracic Surgery Pre and Intraoperative Risk Factors: A Retrospective Clinical Study of a Hundred Forty-Three Cases","volume":"5","author":"Sen","year":"2010","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13019-018-0717-6","article-title":"Risk Factors and Short-Term Outcomes of Postoperative Pulmonary Complications after VATS Lobectomy","volume":"13","author":"Agostini","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1093\/icvts\/ivt292","article-title":"Predictive Factors for Complications of Anatomical Pulmonary Segmentectomies","volume":"17","author":"Traibi","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jtcvs.2014.08.071","article-title":"Effect of the Amount of Intraoperative Fluid Administration on Postoperative Pulmonary Complications Following Anatomic Lung Resections","volume":"149","author":"Arslantas","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1111\/aas.13388","article-title":"Risk Factors for Post-Operative Pulmonary Complications in Lung Cancer Patients after Video-Assisted Thoracoscopic Lung Resection: Results of the German Thorax Registry","volume":"63","author":"Kaufmann","year":"2019","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_15","first-page":"330","article-title":"The German Thorax Registry: Implementation of an Established Tool of Perioperative Health Care Research","volume":"142","author":"Defosse","year":"2017","journal-title":"Zentralbl. Chir."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration","volume":"12","author":"Vandenbroucke","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/EJA.0000000000000118","article-title":"Standards for Definitions and Use of Outcome Measures for Clinical Effectiveness Research in Perioperative Medicine: European Perioperative Clinical Outcome (EPCO) Definitions: A Statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures","volume":"32","author":"Jammer","year":"2015","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s10585-020-10056-w","article-title":"Is Repeated Pulmonary Metastasectomy Justified?","volume":"37","author":"Forster","year":"2020","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Grapatsas, K., D\u00f6rr, F., Menghesha, H., Schuler, M., Gr\u00fcnwald, V., Bauer, S., Schmidt, H.H.-J., Lang, S., Kimmig, R., and Kasper, S. (2023). New Prognostic Score (Essen Score) to Predict Postoperative Morbidity after Resection of Lung Metastases. Cancers, 15.","DOI":"10.3390\/cancers15174355"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"356","DOI":"10.21037\/atm.2019.03.67","article-title":"Anesthetic Considerations for Lung Resection: Preoperative Assessment, Intraoperative Challenges and Postoperative Analgesia","volume":"7","author":"Lederman","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"iii1","DOI":"10.1136\/thx.2010.145938","article-title":"Guidelines on the Radical Management of Patients with Lung Cancer","volume":"65","author":"Lim","year":"2010","journal-title":"Thorax"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1136\/thx.2009.123083","article-title":"Postoperative Pulmonary Complications Following Thoracic Surgery: Are There Any Modifiable Risk Factors?","volume":"65","author":"Agostini","year":"2010","journal-title":"Thorax"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s12931-019-1087-x","article-title":"Prevalence of and Risk Factors for Pulmonary Complications after Curative Resection in Otherwise Healthy Elderly Patients with Early Stage Lung Cancer","volume":"20","author":"Im","year":"2019","journal-title":"Respir. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative Pulmonary Complications","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kasprzak, A. (2021). The Role of Tumor Microenvironment Cells in Colorectal Cancer (CRC) Cachexia. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22041565"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Petrella, F., Casiraghi, M., Radice, D., Bardoni, C., Cara, A., Mohamed, S., Sances, D., and Spaggiari, L. (2022). Unplanned Return to the Operating Room after Elective Oncologic Thoracic Surgery: A Further Quality Indicator in Surgical Oncology. Cancers, 14.","DOI":"10.3390\/cancers14092064"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Alam, N., Park, B.J., Wilton, A., Seshan, V.E., Bains, M.S., Downey, R.J., Flores, R.M., Rizk, N., Rusch, V.W., and Amar, D. (2007). Incidence and Risk Factors for Lung Injury after Lung Cancer Resection. Ann. Thorac. Surg., 84.","DOI":"10.1016\/j.athoracsur.2007.05.053"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1213\/01.ANE.0000087799.85495.8A","article-title":"Risk Factors for Acute Lung Injury after Thoracic Surgery for Lung Cancer","volume":"97","author":"Licker","year":"2003","journal-title":"Anesth. Analg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/1089253213491014","article-title":"Perioperative Fluid Management for Pulmonary Resection Surgery and Esophagectomy","volume":"18","author":"Chau","year":"2014","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5143","DOI":"10.21037\/jtd.2017.10.144","article-title":"The Long-Term Impact of Postoperative Pulmonary Complications after Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer","volume":"9","author":"Wang","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Seely, A.J.E., Ivanovic, J., Threader, J., Al-Hussaini, A., Al-Shehab, D., Ramsay, T., Gilbert, S., Maziak, D.E., Shamji, F.M., and Sundaresan, R.S. (2010). Systematic Classification of Morbidity and Mortality after Thoracic Surgery. Ann. Thorac. Surg., 90.","DOI":"10.1016\/j.athoracsur.2010.05.014"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:42:53Z","timestamp":1760028173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051565"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051565","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]}}}