Postoperative pulmonary complications in patients with bronchiectasis following non-cardiothoracic surgery: a retrospective cohort analysis

BACKGROUND: Risk factors associated with postoperative pulmonary complications (PPCs) in bronchiectasis patients undergoing non-cardiothoracic surgery are not well understood. This study aimed to identify perioperative risk factors for PPCs in bronchiectasis patients undergoing non-cardiothoracic surgery, with particular attention to the relationship between preoperative lung function and complication risk. METHODS: This single-center retrospective study analyzed patients with bronchiectasis who underwent non-cardiothoracic surgery between January 2021 and August 2024. Multivariable logistic regression was used to identify independent risk factors for PPC development. Restricted cubic spline analysis was performed to evaluate non-linear associations between continuous pulmonary function parameters and PPC risk. RESULTS: Of 275 patients with bronchiectasis, 49 (17.8%) developed PPCs. Multivariable analysis identified three risk factors associated with PPCs: lower preoperative FEV1 (% predicted) (Odds ratio [OR] = 0.97 per 1% increase; 95% confidence interval [CI], 0.96–0.99; p = 0.003), abdominal surgery (open and laparoscopic) (OR = 4.14; 95% CI, 1.68–10.23; p = 0.002) and prolonged operative duration (OR = 2.38 per hour; 95% CI, 1.73–3.27; p < 0.001). Restricted cubic spline analysis revealed a significant nonlinear relationship between preoperative FEV1 (% predicted) and risk of PPCs in adjusted models (p = 0.008). Patients with FEV1 ≤ 50% predicted demonstrated a 3.27-fold increased odds of PPCs compared to those with normal lung function (FEV1 > 80% predicted), with the risk being even higher at FEV1 ≤ 30% predicted. CONCLUSIONS: Among bronchiectasis patients undergoing non-cardiothoracic surgery, decreased preoperative FEV1, abdominal surgery, and prolonged operative time were identified as independent risk factors for PPC occurrence.