Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JI Yanli ^1,2 , JIANG Chulaerbu ³ ,  WANG Wenping ² , HU Yang ² , MA Lin ² , YUAN Yong ² , LIN Feng ² , CHE Guowei ²

1. Department of Thoracic Surgery, West China Hospital, Sichuan University/School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, 626000, Sichuan, P. R. China;

Corresponding author：

WANG Wenping, Email: drwangwp@163.com

Keywords：

High-altitude resident; high-altitude medical center; thoracic surgery; postoperative complications

DOI：

10.7507/1007-4848.202111050

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. Methods We retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. Results The rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m² (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). Conclusion Thoracic surgery in the high-altitude medical center is safe and feasible.

Citation： JI Yanli, JIANG Chulaerbu, WANG Wenping, HU Yang, MA Lin, YUAN Yong, LIN Feng, CHE Guowei. Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 95-99. doi: 10.7507/1007-4848.202111050 Copy

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2.	Lei S, Sun Z, He X, et al. Clinical characteristics of pulmonary hypertension patients living in plain and high-altitude regions. Clin Respir J, 2019, 13(8): 485-492.
3.	Wilkins MR, Ghofrani HA, Weissmann N, et al. Pathophysiology and treatment of high-altitude pulmonary vascular disease. Circulation, 2015, 131(6): 582-590.
4.	马宏伟, 丁丽景, 周艳杰, 等. 高原地区手术患者全身麻醉的临床处理. 山西医药杂志, 2019, 48(3): 279-283.
5.	刘刚, 魏秀玲, 杨林江, 等. 中度高海拔地区开胸手术对肺泡表面活性物质的影响. 中华胸部外科电子杂志, 2015, 2(2): 119-122.
6.	潘韫丹, 牛姣姣, 覃罡, 等. 西藏先天性心脏病患儿在低海拔地区行手术麻醉的围手术期安全性. 中南大学学报(医学版), 2017, 42(11): 1288-1292.
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11.	王朋飞, 代伟娜, 刘礼新, 等. 高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响. 肿瘤研究与临床, 2019, 31(3): 167-171.
12.	刘杰, 吴穹, 李英莲, 等. 高海拔地区高TC、高TG、高GLU血症与高血压、肥胖的调查分析. 高原医学杂志, 2012, 22(2): 13-17.
13.	刘刚, 魏秀玲, 杨林江, 等. 中度高海拔地区肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及安全性. 广东医学, 2016, 37(6): 871-873.
14.	Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg, 2011, 39(5): 738-744.
15.	Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
16.	王朋飞. 应用倾向评分匹配法评价术前体重指数对非小细胞肺癌围手术期及远期预后的影响. 兰州大学, 2020.
17.	Chang MY, Chang ML, Wu CT. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report. World J Gastroenterol, 2006, 12(44): 7213-7215.
18.	Bellaiche S, Di Blasio R, Luauté J, et al. Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med, 2013, 56(1): 41-50.
19.	周乃康, 崔忠厚, 王芳泽. 胸外科疾病病案分析. 北京: 科学出版社, 2006. 154-159.
20.	Dayen C, Mishellany H, Hellmuth D, et al. Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature. Rev Mal Respir, 2001, 18(5): 537-540.

1. Pasha MA, Newman JH. High-altitude disorders: Pulmonary hypertension: Pulmonary vascular disease: The global perspective. Chest, 2010, 137(6 Suppl): 13S-19S.
2. Lei S, Sun Z, He X, et al. Clinical characteristics of pulmonary hypertension patients living in plain and high-altitude regions. Clin Respir J, 2019, 13(8): 485-492.
3. Wilkins MR, Ghofrani HA, Weissmann N, et al. Pathophysiology and treatment of high-altitude pulmonary vascular disease. Circulation, 2015, 131(6): 582-590.
4. 马宏伟, 丁丽景, 周艳杰, 等. 高原地区手术患者全身麻醉的临床处理. 山西医药杂志, 2019, 48(3): 279-283.
5. 刘刚, 魏秀玲, 杨林江, 等. 中度高海拔地区开胸手术对肺泡表面活性物质的影响. 中华胸部外科电子杂志, 2015, 2(2): 119-122.
6. 潘韫丹, 牛姣姣, 覃罡, 等. 西藏先天性心脏病患儿在低海拔地区行手术麻醉的围手术期安全性. 中南大学学报(医学版), 2017, 42(11): 1288-1292.
7. 德庆多吉. 不同海拔对术后切口感染情况分析. 西藏医药, 2020, 41(5): 56-57.
8. Xu R, Zhou S, Yang J, et al. Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude. J Int Med Res, 2017, 45(1): 246-253.
9. Grimminger J, Richter M, Tello K, et al. Thin air resulting in high pressure: Mountain sickness and hypoxia-induced pulmonary hypertension. Can Respir J, 2017, 2017: 8381653.
10. Swenson ER, Bärtsch P, eds. High Altitude: Human Adaptation to Hypoxia. Germany: Springer, 2014.
11. 王朋飞, 代伟娜, 刘礼新, 等. 高体质量指数对胸腔镜下肺癌根治术围术期并发症及临床疗效的影响. 肿瘤研究与临床, 2019, 31(3): 167-171.
12. 刘杰, 吴穹, 李英莲, 等. 高海拔地区高TC、高TG、高GLU血症与高血压、肥胖的调查分析. 高原医学杂志, 2012, 22(2): 13-17.
13. 刘刚, 魏秀玲, 杨林江, 等. 中度高海拔地区肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及安全性. 广东医学, 2016, 37(6): 871-873.
14. Petrella F, Radice D, Borri A, et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg, 2011, 39(5): 738-744.
15. Williams T, Gulack BC, Kim S, et al. Operative risk for major lung resection increases at extremes of body mass index. Ann Thorac Surg, 2017, 103(1): 296-302.
16. 王朋飞. 应用倾向评分匹配法评价术前体重指数对非小细胞肺癌围手术期及远期预后的影响. 兰州大学, 2020.
17. Chang MY, Chang ML, Wu CT. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report. World J Gastroenterol, 2006, 12(44): 7213-7215.
18. Bellaiche S, Di Blasio R, Luauté J, et al. Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med, 2013, 56(1): 41-50.
19. 周乃康, 崔忠厚, 王芳泽. 胸外科疾病病案分析. 北京: 科学出版社, 2006. 154-159.
20. Dayen C, Mishellany H, Hellmuth D, et al. Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature. Rev Mal Respir, 2001, 18(5): 537-540.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and feasibility of thoracic surgery for high-altitude patients in the high-altitude medical center

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