Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Daniel J. Boffa

Abstract

Up to 40% of lobectomies are complicated by adverse events. Gastroesophageal reflux disease (GERD) and hiatal hernia have been associated with cardiopulmonary pathology across a range of clinical scenarios, yet their relation to complications after pulmonary resection is understudied. We hypothesized GERD and hiatal hernia are predictors of complications after lobectomy for lung cancer. Lobectomy patients at Yale-New Haven Hospital between January 2014 and April 2021 were evaluated for predictors of 30-day post-operative complications, pneumonia, atrial arrhythmia, readmission, and mortality. Multivariable regression models included sociodemographic characteristics, BMI, surgical approach, cardiopulmonary comorbidities, hiatal hernia, GERD, and acid suppressive therapy as predictors. Overall, 824 patients underwent lobectomy, including 50.5% with a hiatal hernia and 38.7% with GERD. The median age was 68 [IQR 61-74] years and the majority were female (58.4%). At least one postoperative complication developed in 39.6% of patients, including atrial arrhythmia (11.7%) and pneumonia (4.1%). Male sex (OR 1.51, 95% CI [1.11-2.06], p=.01), age ≥70 years (OR 1.55, 95% CI [1.13-2.11], p=.01), hiatal hernia (OR 1.40, 95% CI [1.03-1.90], p=.03), and intraoperative packed RBCs (OR 4.80, 95% CI [1.51-15.20], p=.01) were significant risk factors for developing at least one postoperative complication. Hiatal hernia was also a significant predictor of atrial arrhythmia (OR 1.64, 95% CI [1.02-2.62], p=.04) but was not associated with other adverse events. Our findings indicate that hiatal hernia may be a novel risk factor for complications, especially atrial arrhythmia, following lobectomy that should be considered in the preoperative evaluation of lung cancer patients.

Comments

This is an Open Access Thesis.

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