Comorbidities as predictors of postoperative pulmonary complications after lung cancer surgery

BACKGROUND: Lung surgery remains the cornerstone of curative treatment for lung cancer, providing the best long-term survival in resectable disease. Advances in operative techniques and perioperative management have made it a safe and effective procedure, even in elderly or comorbid patients. Nevertheless, postoperative pulmonary complications (PPCs) remain a major source of morbidity and mortality. While surgical magnitude and functional capacity are recognised determinants, the contribution of comorbidities has not been adequately quantified. This study evaluated the relationship between cardiac, pulmonary, and metabolic comorbidities and postoperative complications in patients undergoing lung-cancer resection. METHODS: A retrospective cohort of 328 patients who underwent lung-cancer surgery during 2018–2024 was analysed. Variables included age, sex, BMI, pulmonary-function tests, and comorbidities {chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), dyslipidemia, hypertension, diabetes, smoking, chronic renal disease}. Logistic-regression models estimated odds ratios and adjusted ORs for predictors of any PPC. RESULTS: PPCs occurred in 97/328 patients (29.6%). Univariate analysis identified COPD, CAD, and dyslipidemia as significant predictors (p < 0.05). In multivariable analysis adjusted for age, sex, BMI, and FEV1/FVC, COPD (aOR 2.8, 95% CI 1.4–5.4), CAD (aOR 2.3, 95% CI 1.1–4.9), and dyslipidemia (aOR 2.6, 95% CI 1.1–6.1) remained independent predictors of complications. A comorbidity-burden score showed a 40% increase in odds of PPCs per additional comorbidity (aOR 1.4 per point, p = 0.02). CONCLUSIONS: Lung cancer surgery is a safe procedure however it has to be performed in properly selected patients due to risk of complications. Cardiac, pulmonary, and metabolic comorbidities—particularly COPD, coronary artery disease, and dyslipidemia—are independent predictors of postoperative pulmonary complications. Comprehensive preoperative evaluation and optimisation of these comorbidities are essential to minimise perioperative risk and improve outcomes after lung-cancer resection.