ASSOCIATION BETWEEN INTRAOPERATIVE ELECTROLYTE AND ACID–BASE DISTURBANCE WITH ACUTE POSTOPERATIVE MYOCARDIAL INJURY IN LUNG CANCER RESECTION UNDER ONE-LUNG VENTILATION

Abstract

Background Postoperative myocardial injury and its correlation with intraoperative electrolytic and acid-base disorder are not clear. This study sought to determine postoperative myocardial injury incidence and its potential link with intraoperative electrolytic and acid-base disorder for patients without cardiovascular and renal diseases scheduled for lung cancer resection.

Purpose The present study sought to determine the incidence of acute postoperative myocardial injury and associated–risk factors, and assess its potential relationship with intraoperative electrolytes and acid–base disorders in patients without known cardiovascular and renal diseases who underwent elected lung cancer resection.

Methods This retrospective observational study received approval from the Medical Ethics committee of NanFang Hospital of Southern Medical University, and adheres to the STROBE principles. This study enrolled every patient scheduled for lung cancer resection. The exclusion criteria included patients with cardiovascular and renal diseases, preoperative hs–cTnT and NT–proBNP levels ≥ 0. 14  ng/ml and ≥ 125 pg/mL, respectively, and an eGFR< 45 ml/min. Statistics were handled via 25 IBM SPSS software packages, and the chi–square test was used to compare categorical variables.  A P–value less than 0.05 was considered statistically significant.

Results Among the 1175 clients, acute postoperative myocardial injury occurred in 79 (6.7%) clients. Electrolytic imbalance, sex, type of resection, intraoperative transfusion, one–lung ventilation and surgery durations, and estimated blood loss were identified as factors for postoperative myocardial injury. Among the 79 patients who experienced postoperative myocardial injury, 78(98.7%) patients had experienced intraoperative electrolyte disorder, and electrolytic disorder was therefore associated with postoperative myocardial injury [P<0.001, OR95%CI: 22.1(3.06~159.71)].

Conclusions In this study, the incidence of postoperative myocardial injury was 6.7%, and electrolytic disorders were a relevant associated-risk factor. Even patients without known cardiovascular and renal diseases prior to surgery may experience acute postoperative myocardial injury. Systematic cardiac biomarkers screening before and after lung cancer surgery may help to prevent or reduce its incidence.