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Predictors of postoperative complications in elderly patients undergoing pulmonary lobectomy: a retrospective cohort study
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DOI：10.3389/fmed.2026.1789608.png)
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Abstract
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BackgroundElderly patients undergoing pulmonary lobectomy for lung cancer are at increased risk of postoperative morbidity. Identifying modifiable risk factors and establishing a practical risk stratification method are essential for improving perioperative management.MethodsThis retrospective cohort study included 212 consecutive patients aged ≥65 years who underwent pulmonary lobectomy for non-small cell lung cancer from 2020 to 2024. Demographic; clinical; and surgical data were collected. The primary outcome was major postoperative complications (Clavien-Dindo grade ≥III). Independent predictors were identified using multivariable logistic regression; and a simplified risk score was constructed. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test.ResultsMajor complications occurred in 73 patients (34.4%). Multivariable analysis identified three independent predictors: age ≥70 years (OR = 2.26; 95% CI: 1.18–4.42); Age-Adjusted Charlson Comorbidity Index (ACCI) ≥ 6 (OR = 3.70; 95% CI: 1.95–7.25); and preoperative hemoglobin <12 g/dL (OR = 3.04; 95% CI: 1.32–7.19). The multivariable model showed good discrimination (AUC = 0.712; 95% CI: 0.645–0.789) and calibration (Hosmer-Lemeshow p = 0.562). A simple risk score assigning one point per predictor demonstrated comparable discrimination (AUC = 0.699; 95% CI: 0.634–0.738) and a stepwise increase in complication rates: 26.0% (score 1); 54.7% (score 2); and 63.6% (score 3).ConclusionA risk score based on age ≥70 years; ACCI ≥6; and preoperative anemia effectively stratifies elderly patients by their risk of major complications after pulmonary lobectomy. This simple tool may facilitate preoperative counseling; guide targeted optimization; and inform perioperative resource allocation; though external validation is warranted.
Keywords:
postoperative complications
non-small cell lung cancer
elderly patients
age-adjusted Charlson comorbidity index score
pulmonary lobectomy
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