Incidence and risk factor analysis of postoperative complications after lung cancer surgery based on CT follow-up

Surgery is the primary treatment method for early-stage lung cancer, but postoperative complications remain an important factor affecting patient prognosis. This study aimed to evaluate the incidence, types, and risk factors of postoperative complications after lung cancer surgery through chest CT follow-up and to establish a prediction model to guide clinical practice. We retrospectively analyzed clinical data of 468 patients who underwent radical lung cancer surgery from January 2020 to December 2022. All patients underwent chest CT follow-up at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Univariate and multivariate logistic regression analyses were used to evaluate risk factors for postoperative complications and to establish a prediction model. Among 468 patients, the incidence of postoperative complications was 27.1% (127 cases). The most common complications included atelectasis (9.6%), pulmonary infection (7.3%), prolonged air leak (5.8%), pleural effusion (3.8%), and arrhythmia (2.6%). Most complications (76.4%) occurred within 3 months after surgery. Multivariate analysis showed that advanced age (≥70 years) (OR=2.35), history of COPD (OR=2.87), preoperative FEV1/FVC<70% (OR=1.78), thoracotomy approach (OR=1.92), prolonged operation time (≥180 minutes) (OR=1.74), and increased intraoperative blood loss (≥200ml) (OR=1.68) were independent risk factors for postoperative complications. The prediction model based on age, surgical approach, extent of resection, and preoperative comorbidities achieved an area under the ROC curve (AUC) of 0.82, with a sensitivity of 81.3% and specificity of 75.6%. The individualized follow-up strategy based on risk stratification (low, intermediate, and high risk) reduced unnecessary imaging examinations by 28.4% while improving the early detection rate of complications. The incidence of postoperative complications after lung cancer surgery is relatively high and mainly concentrated in the early postoperative period. Advanced age, history of COPD, impaired lung function, thoracotomy approach, prolonged operation time, and increased intraoperative blood loss are independent risk factors for postoperative complications. The prediction model based on CT follow-up has good predictive value and can guide the development of individualized follow-up strategies to promote early identification and timely intervention of postoperative complications, thereby improving patient prognosis.