Background and Aims Inadequate postoperative pain control is associated with poor prognosis after surgery. Lung transplantation (LTX) patients are usually on mechanical ventilation with sedation in the immediate postoperative period, making it difficult to accurately measure postoperative pain. Instead, surrogate indices could be used to measure patient’s postoperative recovery, such as days alive and out of hospital (DAOH), which is a patient- centered outcome measure. This study aimed to evaluate DAOH as a predictor of prognosis after LTX.
Methods We retrospectively included 246 patients who undergoing LTX at Severance Hospital, between 2012 and 2021. The optimal cut-off DAOH for prediction of postoperative overall survival was at 21.5 days using receiver operating characteristic analysis. We compared the preoperative, intraoperative and postoperative variables between LTX patients with DAOH>21.5 and those with DAOH<21.5.
Results Patients with DAOH<21.5 were older (60 vs. 56 yrs) and more patients with DOAH<21.5 were hospitalized (66% vs. 52%), admitted in the intensive care unit (55% vs. 35%) and on mechanical ventilation (48% vs. 27%) compared to those with a DAOH>21.5. More patients with DAOH> 21.5 were successfully weaned from extracorporeal membrane oxygenation during surgery (65% vs. 43%). The incidence of acute kidney injury, postoperative reoperation, pneumonia and sepsis were higher in patients with DAOH<21.5. Survival at 1 month and 1 year were significant higher in the DAOH>21.5 group compared to those with DAOH<21.5 (100% vs. 81% and 89% vs.47%).
Conclusions Our findings suggest that the DAOH, which is a patient-centered outcome, is a useful surrogate marker for indicating patient’s postoperative recovery after LTX.
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