Postoperative acute exacerbations in patients with idiopathic pulmonary fibrosis undergoing lung cancer surgery

Abstract

Background and aim: This study aimed to evaluate the incidence, risk factors, and mortality associated with postoperative acute exacerbations in patients with IPF who underwent lung cancer surgery. Methods: We retrospectively reviewed 1,225 lung cancer surgeries performed between 2018 and 2024, and identified 40 patients who met the ATS/ERS criteria for IPF. Acute exacerbations were defined as new bilateral ground-glass opacities and/or consolidation superimposed on preexisting fibrosis within 30 days postoperatively. Univariate and multivariate logistic regression analyses were performed to evaluate clinical, radiological, functional, and pathological variables as potential risk factors for acute exacerbations and mortality Results: Postoperative acute exacerbations occurred in 15% (6/40) of patients, with a 30-day mortality rate of 83.3%. Multivariate logistic regression analysis identified lesion size >3 cm (OR=3.50, 95% CI: 1.80–6.80, p<0.001) and shorter IPF follow-up duration (OR=2.90, 95% CI: 1.50–5.70, p<0.001) as independent risk factors for postoperative acute exacerbation. Postoperative acute exacerbation was strongly associated with increased mortality (OR=0.026, 95% CI: 0.001–0.715, p=0.031). Overall mortality was 40%, and multivariate analysis demonstrated a significant association with preexisting emphysema (OR=6.998, 95% CI: 1.926–25.449, p=0.003) and long-term oxygen therapy (OR=5.845, 95% CI: 1.475–23.147, p=0.012). Conclusions: Postoperative acute exacerbations remain a serious complication associated with substantial mortality in patients with IPF undergoing lung cancer surgery. Tumor characteristics, particularly lesion size and location, may play an important role in preoperative risk stratification and perioperative management.