Thromboembolism after pneumonectomy for malignancy

An independent marker of poor outcome

David P. Mason*, Mohammad A. Quader, Eugene H. Blackstone, Jeevanantham Rajeswaran, Malcolm M. DeCamp, Sudish C. Murthy, Angela K. Quader, Thomas W. Rice

*Corresponding author for this work

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: Because venous thromboembolism results in important postoperative morbidity and mortality after pneumonectomy for malignancy, we sought to determine its prevalence, location, management, timing, and risk factors. We also evaluated short- and long-term outcomes of patients in whom venous thromboembolism developed compared with those of patients in whom it did not. Methods: Between January 1990 and January 2001, 336 patients underwent pneumonectomy for malignancy. Patients were considered to have venous thromboembolism if they were identified as having deep vein thrombosis or pulmonary embolus through chart review, including pulmonary imaging studies. All patients were managed with anticoagulation or anticoagulation plus thrombolysis. Results: Twenty-five (7.4%) patients had postoperative venous thromboembolism, with peak incidence 7 days after the operation; most had already been discharged from the hospital. Higher pack-years of smoking was associated with increased risk, as well as with earlier occurrence of venous thromboembolism (P < .04). Survival was 55% at 6 months and 13% at 18 months; mode of death was cancer in 14 (61%) of 23, respiratory failure in 4 (17%) of 23, multisystem organ failure in 3 (13%) of 23, myocardial infarction in 1 (4.4%) of 23, and uncertain in 1 (4.4%) of 23. Low preoperative forced vital capacity was predictive of poor long-term survival (P = .02). Patients with venous thromboembolism had substantially lower survival than predicted from competing-risks analysis of survival without venous thromboembolism (13% vs 60% at 18 months), and this difference persisted after censoring for deaths directly attributable to venous thromboembolism. Conclusions: Venous thromboembolism is surprisingly common after pneumonectomy for malignancy and portends poor survival. Improved screening and better prophylaxis might prevent this complication and enhance outcome.

Original languageEnglish (US)
Pages (from-to)711-718
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume131
Issue number3
DOIs
StatePublished - Mar 1 2006

Fingerprint

Pneumonectomy
Thromboembolism
Venous Thromboembolism
Neoplasms
Survival
Lung
Vital Capacity
Survival Analysis
Embolism
Venous Thrombosis
Respiratory Insufficiency
Smoking
Myocardial Infarction
Morbidity
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Mason, D. P., Quader, M. A., Blackstone, E. H., Rajeswaran, J., DeCamp, M. M., Murthy, S. C., ... Rice, T. W. (2006). Thromboembolism after pneumonectomy for malignancy: An independent marker of poor outcome. Journal of Thoracic and Cardiovascular Surgery, 131(3), 711-718. https://doi.org/10.1016/j.jtcvs.2005.10.027
Mason, David P. ; Quader, Mohammad A. ; Blackstone, Eugene H. ; Rajeswaran, Jeevanantham ; DeCamp, Malcolm M. ; Murthy, Sudish C. ; Quader, Angela K. ; Rice, Thomas W. / Thromboembolism after pneumonectomy for malignancy : An independent marker of poor outcome. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 131, No. 3. pp. 711-718.
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Mason, DP, Quader, MA, Blackstone, EH, Rajeswaran, J, DeCamp, MM, Murthy, SC, Quader, AK & Rice, TW 2006, 'Thromboembolism after pneumonectomy for malignancy: An independent marker of poor outcome', Journal of Thoracic and Cardiovascular Surgery, vol. 131, no. 3, pp. 711-718. https://doi.org/10.1016/j.jtcvs.2005.10.027

Thromboembolism after pneumonectomy for malignancy : An independent marker of poor outcome. / Mason, David P.; Quader, Mohammad A.; Blackstone, Eugene H.; Rajeswaran, Jeevanantham; DeCamp, Malcolm M.; Murthy, Sudish C.; Quader, Angela K.; Rice, Thomas W.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 131, No. 3, 01.03.2006, p. 711-718.

Research output: Contribution to journalArticle

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T1 - Thromboembolism after pneumonectomy for malignancy

T2 - An independent marker of poor outcome

AU - Mason, David P.

AU - Quader, Mohammad A.

AU - Blackstone, Eugene H.

AU - Rajeswaran, Jeevanantham

AU - DeCamp, Malcolm M.

AU - Murthy, Sudish C.

AU - Quader, Angela K.

AU - Rice, Thomas W.

PY - 2006/3/1

Y1 - 2006/3/1

N2 - Objective: Because venous thromboembolism results in important postoperative morbidity and mortality after pneumonectomy for malignancy, we sought to determine its prevalence, location, management, timing, and risk factors. We also evaluated short- and long-term outcomes of patients in whom venous thromboembolism developed compared with those of patients in whom it did not. Methods: Between January 1990 and January 2001, 336 patients underwent pneumonectomy for malignancy. Patients were considered to have venous thromboembolism if they were identified as having deep vein thrombosis or pulmonary embolus through chart review, including pulmonary imaging studies. All patients were managed with anticoagulation or anticoagulation plus thrombolysis. Results: Twenty-five (7.4%) patients had postoperative venous thromboembolism, with peak incidence 7 days after the operation; most had already been discharged from the hospital. Higher pack-years of smoking was associated with increased risk, as well as with earlier occurrence of venous thromboembolism (P < .04). Survival was 55% at 6 months and 13% at 18 months; mode of death was cancer in 14 (61%) of 23, respiratory failure in 4 (17%) of 23, multisystem organ failure in 3 (13%) of 23, myocardial infarction in 1 (4.4%) of 23, and uncertain in 1 (4.4%) of 23. Low preoperative forced vital capacity was predictive of poor long-term survival (P = .02). Patients with venous thromboembolism had substantially lower survival than predicted from competing-risks analysis of survival without venous thromboembolism (13% vs 60% at 18 months), and this difference persisted after censoring for deaths directly attributable to venous thromboembolism. Conclusions: Venous thromboembolism is surprisingly common after pneumonectomy for malignancy and portends poor survival. Improved screening and better prophylaxis might prevent this complication and enhance outcome.

AB - Objective: Because venous thromboembolism results in important postoperative morbidity and mortality after pneumonectomy for malignancy, we sought to determine its prevalence, location, management, timing, and risk factors. We also evaluated short- and long-term outcomes of patients in whom venous thromboembolism developed compared with those of patients in whom it did not. Methods: Between January 1990 and January 2001, 336 patients underwent pneumonectomy for malignancy. Patients were considered to have venous thromboembolism if they were identified as having deep vein thrombosis or pulmonary embolus through chart review, including pulmonary imaging studies. All patients were managed with anticoagulation or anticoagulation plus thrombolysis. Results: Twenty-five (7.4%) patients had postoperative venous thromboembolism, with peak incidence 7 days after the operation; most had already been discharged from the hospital. Higher pack-years of smoking was associated with increased risk, as well as with earlier occurrence of venous thromboembolism (P < .04). Survival was 55% at 6 months and 13% at 18 months; mode of death was cancer in 14 (61%) of 23, respiratory failure in 4 (17%) of 23, multisystem organ failure in 3 (13%) of 23, myocardial infarction in 1 (4.4%) of 23, and uncertain in 1 (4.4%) of 23. Low preoperative forced vital capacity was predictive of poor long-term survival (P = .02). Patients with venous thromboembolism had substantially lower survival than predicted from competing-risks analysis of survival without venous thromboembolism (13% vs 60% at 18 months), and this difference persisted after censoring for deaths directly attributable to venous thromboembolism. Conclusions: Venous thromboembolism is surprisingly common after pneumonectomy for malignancy and portends poor survival. Improved screening and better prophylaxis might prevent this complication and enhance outcome.

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