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Postoperative cerebral infarction and arrhythmia after pulmonary lobectomy in Japan: a retrospective analysis of 77,060 cases in a national clinical database

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Abstract

Purpose

To investigate the incidence of postoperative cerebral infarction after curative lobectomy, its association with the type of lobectomy, and how postoperative new-onset arrhythmia contributes to postoperative cerebral infarction.

Methods

The subjects of this analysis were 77,060 patients who underwent curative lobectomy for lung cancer between 2016 and 2018 according to the National Clinical Database. Incidences of postoperative cerebral infarction and postoperative new-onset arrhythmia were analyzed. Moreover, mediation analysis was performed to evaluate the causal pathway between postoperative new-onset arrhythmia and postoperative cerebral infarction.

Results

Postoperative cerebral infarction occurred in 110 (0.7%) patients after left upper lobectomy and in 85 (0.7%) patients after left lower lobectomy. Left upper lobectomy and left lower lobectomy were associated with a higher likelihood of postoperative cerebral infarction than right lower lobectomy. Left upper lobectomy was the strongest independent predictor of postoperative new-onset arrhythmia. However, in the mediation analysis, the odds ratio for cerebral infarction did not change after the addition of the factor of postoperative new-onset arrhythmia.

Conclusion

Cerebral infarction occurred significantly more often not only after left upper lobectomy, but also after left lower lobectomy. Postoperative new-onset arrhythmia was less likely to be related to cerebral infarction after left upper lobectomy.

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Data availability

The data underlying this article were provided by NCD (definitions available online at http://www.ncd.or.jp) under license. Data will be shared on request to the corresponding author with permission of the NCD.

Abbreviations

NCD:

National Clinical Database

POAF:

Postoperative atrial fibrillation

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Acknowledgements

We thank all the data managers and hospitals participating in this NCD project for their considerable help with the data entry. This work was submitted and accepted with the endorsement and support of the Japanese Association for Thoracic Surgery for the "Open call for new multidisciplinary research proposals using NCD data" in 2018. It was presented at the 75th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery, Yokohama, Japan, Oct 5–8, 2022.

Author information

Authors and Affiliations

  1. The Japanese Association for Thoracic Surgery, Tokyo, Japan

    Daisuke Kimura, Shunsuke Endo, Ikuo Fukuda, Hitoshi Ogino, Yoshiki Sawa, Masayuki Chida & Masahito Minakawa

  2. Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

    Daisuke Kimura & Masahito Minakawa

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroyuki Yamamoto, Eriko Fukuchi & Hiroaki Miyata

  4. Department of Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Shunsuke Endo

  5. Cardiovascular Center, Suita Tokushukai Hospital, Osaka, Japan

    Ikuo Fukuda

  6. Department of Cardiovascular Surgery, Tokyo Medical University Hospital, Tokyo, Japan

    Hitoshi Ogino

  7. Osaka Police Hospital, Osaka, Japan

    Yoshiki Sawa

  8. Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan

    Masayuki Chida

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  1. Daisuke Kimura
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Contributions

DK: conceptualization; data curation; formal analysis; investigation; methodology; project administration; visualization; writing-original draft. HY: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. SE: conceptualization; data curation; formal analysis; investigation; methodology; project administration; supervision; visualization; writing-review & editing. EF: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. HM: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. IF: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. HO: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. YS: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. MC: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing. MM: conceptualization; data curation; formal analysis; investigation; methodology; writing-review & editing.

Corresponding author

Correspondence to Daisuke Kimura.

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Conflict of interest

Hiroyuki Yamamoto, Eriko Fukuchi, and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. This department is a social collaboration department that is supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Co., but they have no conflicts of interest regarding this research. Other authors declare that they have no potential conflicts of interest related to this manuscript.

Ethical approval

This study was approved by The Committee of Medical Ethics of Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Approval Number 2019‑1036; August 9, 2019), and the need for informed consent was waived.

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Kimura, D., Yamamoto, H., Endo, S. et al. Postoperative cerebral infarction and arrhythmia after pulmonary lobectomy in Japan: a retrospective analysis of 77,060 cases in a national clinical database. Surg Today 53, 1388–1395 (2023). https://doi.org/10.1007/s00595-023-02691-z

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