Mortality in respiratory failure following thoracic surgical procedures: what are the risk factors?

Background: Respiratory failure after thoracic surgery significantly increases ICU admissions and mortality. This study aimed to identify predictors of ICU mortality in these patients. Methods: Adults admitted to the ICU with postoperative respiratory failure between April 2022 and October 2025 were analyzed. Demographics, comorbidities, severity scores (APACHE II, SOFA, Charlson), laboratory results, and first-day arterial blood gases were recorded. Variables with p < 0.10 in univariate analysis entered multivariate logistic regression. Results: Ninety-seven patients (median age 67 years; 75% male) were included. ICU mortality was 31%. Nonsurvivors had higher APACHE II (31 ± 7.8 vs 21 ± 7.4, p < 0.001), SOFA (6 vs 5, p < 0.001), and Charlson (8 vs 5, p < 0.001) scores. CRP (202 vs 134 mg/L, p = 0.029) and procalcitonin were elevated, while pH (7.31 vs 7.38, p = 0.005) and PaO₂/FiO₂ (140 vs 166, p = 0.009) were lower. NIV use was less frequent among nonsurvivors (17% vs 39%, p = 0.036). CRP remained the only independent predictor of ICU mortality (OR 1.011, 95% CI 1.003–1.018, p = 0.006). Conclusion: In postoperative respiratory failure, systemic inflammation and disease severity were key determinants of outcome. Elevated CRP independently predicted ICU mortality, emphasizing early inflammatory response as a prognostic marker. NIV’s association with improved survival supports its early use. Integrating biomarkers with severity scores may guide timely interventions and optimize ICU management. AI Declaration: ChatGPT (OpenAI, USA) was used for language editing and formatting assistance. The author reviewed and approved the final version.