Impaired oxygenation after lung resection: Incidence and perioperative risk factors

J Clin Anesth. 2024 Sep:96:111485. doi: 10.1016/j.jclinane.2024.111485. Epub 2024 May 7.


Study objective: To estimate the incidence of postoperative oxygenation impairment after lung resection in the era of lung-protective management, and to identify perioperative factors associated with that impairment.

Design: Registry-based retrospective cohort study.

Setting: Two large academic hospitals in the United States.

Patients: 3081 ASA I-IV patients undergoing lung resection.

Measurements: 79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92%; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen).

Main results: Oxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO2/FiO2 < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmH2O of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO2 (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm H2O) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects.

Conclusions: Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.

Keywords: Driving pressure; Hypoxemia; Intraoperative mechanical ventilation; Lung injury; Lung protective ventilation; Thoracic surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Oxygen / blood
  • Oxygen Inhalation Therapy* / methods
  • Oxygen Inhalation Therapy* / statistics & numerical data
  • Pneumonectomy* / adverse effects
  • Positive-Pressure Respiration / adverse effects
  • Positive-Pressure Respiration / methods
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology


  • Oxygen