Resumé

Background and Purpose- After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls. Methods- We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer. Results- The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95% CI, 2.04-7.12) and 5.43 (95% CI, 3.99-7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95% CI, 1.39-6.25) and for patients without atrial fibrillation (IRR, 2.56; 95% CI, 1.86-3.59).When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95% CI, 1.19-5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95% CI, 0.72-12.29). Conclusions- Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.

OriginalsprogEngelsk
TidsskriftStroke
Vol/bind50
Udgave nummer5
Sider (fra-til)1052-1059
Antal sider8
ISSN0039-2499
DOI
StatusUdgivet - maj 2019

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Pneumonectomy
Stroke
Incidence
Lung Neoplasms
Pulmonary Veins
Atrial Fibrillation
Regression Analysis
Population Control
Population
Registries

Citer dette

@article{bb1da7273a854603abe1251733d3f91f,
title = "Incidence of Stroke After Pneumonectomy and Lobectomy: A Nationwide, Register-Based Study",
abstract = "Background and Purpose- After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls. Methods- We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer. Results- The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95{\%} CI, 2.04-7.12) and 5.43 (95{\%} CI, 3.99-7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95{\%} CI, 1.39-6.25) and for patients without atrial fibrillation (IRR, 2.56; 95{\%} CI, 1.86-3.59).When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95{\%} CI, 1.19-5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95{\%} CI, 0.72-12.29). Conclusions- Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.",
author = "Signe Riddersholm and Bhupendar Tayal and Kristian Kragholm and Andreasen, {Jan Jesper} and Rasmussen, {Bodil Steen} and Peter S{\o}gaard and Christian Torp-Pedersen and Sam Riahi",
year = "2019",
month = "5",
doi = "10.1161/STROKEAHA.118.024496",
language = "English",
volume = "50",
pages = "1052--1059",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams & Wilkins",
number = "5",

}

TY - JOUR

T1 - Incidence of Stroke After Pneumonectomy and Lobectomy

T2 - A Nationwide, Register-Based Study

AU - Riddersholm, Signe

AU - Tayal, Bhupendar

AU - Kragholm, Kristian

AU - Andreasen, Jan Jesper

AU - Rasmussen, Bodil Steen

AU - Søgaard, Peter

AU - Torp-Pedersen, Christian

AU - Riahi, Sam

PY - 2019/5

Y1 - 2019/5

N2 - Background and Purpose- After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls. Methods- We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer. Results- The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95% CI, 2.04-7.12) and 5.43 (95% CI, 3.99-7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95% CI, 1.39-6.25) and for patients without atrial fibrillation (IRR, 2.56; 95% CI, 1.86-3.59).When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95% CI, 1.19-5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95% CI, 0.72-12.29). Conclusions- Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.

AB - Background and Purpose- After pneumonectomy or lobectomy, at least 1 blind pulmonary vein is left with potential risk of postoperative thromboembolic incidents. We investigated the risk of stroke within this population compared with background and pulmonary wedge resections controls. Methods- We identified 12 965 patients with pneumonectomy or lobectomy and 6400 patients with wedge resection using data from Danish nationwide registries from 1996 to 2016. In multivariate Poisson regression analysis, we estimated incidence rate ratios of stroke for patients undergoing lobectomy or pneumonectomy versus background population controls and patients who underwent wedge resection. We stratified our analysis by days: 0 to 30, 31 to 90, 91 to 180, and 180 to 365 after surgery and performed a subgroup analysis in patients with lung cancer. Results- The incidence rate of stroke was 10.6 per 1000 person-years for time exposed for pneumonectomy or lobectomy and 2.3 per 1000 person-years for patients not exposed for pneumonectomy or lobectomy. In the 0- to 30-day multivariate Poisson regression analysis, compared with the background population, pneumonectomy or lobectomy was associated with an increased risk of stroke both patients with and without atrial fibrillation (incidence rate ratios [IRR]) of 4.66 (95% CI, 2.04-7.12) and 5.43 (95% CI, 3.99-7.41), respectively. Similarly, in patients with lung cancer, the first 30 days after pneumonectomy or lobectomy remained a risk factor for stroke for patients with (IRR, 2.94; 95% CI, 1.39-6.25) and for patients without atrial fibrillation (IRR, 2.56; 95% CI, 1.86-3.59).When compared with wedge resection, 0 to 30 days after lobectomy or pneumonectomy was also associated with increased risk of stroke (IRR, 2.63; 95% CI, 1.19-5.81); however, this association was insignificant in patients with lung cancer (IRR, 2.98; 95% CI, 0.72-12.29). Conclusions- Patients undergoing pneumonectomy or lobectomy had an increased 30 days risk of stroke. Whether the pulmonary vein stump is a risk factor for stroke and whether preventive strategies are relevant require further investigation.

U2 - 10.1161/STROKEAHA.118.024496

DO - 10.1161/STROKEAHA.118.024496

M3 - Journal article

VL - 50

SP - 1052

EP - 1059

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 5

ER -