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

BACKGROUND AND AIM: This study evaluated the incidence, risk factors, and mortality associated with postoperative acute exacerbations in IPF patients undergoing lung cancer surgery. METHODS: We retrospectively reviewed 1,225 lung cancer surgeries performed between 2018-2024, identifying 40 patients meeting ATS/ERS criteria for IPF. Acute exacerbations were defined as new bilateral ground-glass opacities superimposed on preexisting fibrosis within 30 days postoperatively. Clinical, radiological, functional, and pathological data were analyzed using univariate and multivariate logistic regression to identify risk factors for acute exacerbations and mortality. RESULTS: Postoperative acute exacerbations occurred in 15% (6/40) of patients, with 83.3% mortality within 30 days. Multivariate analysis confirmed lesion size >3cm (OR=3.50, 95%CI: 1.80-6.80, p<0.001), shorter IPF follow-up duration (OR=2.90, 95%CI: 1.50-5.70, p<0.001), and mortality (OR=0.026, 95%CI: 0.001-0.715, P=0.031) as independent risk factors. Overall mortality was 40%, significantly associated 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 are serious complications with high mortality in IPF patients undergoing lung cancer surgery. Tumor characteristics, particularly size and location, should guide preoperative risk assessment and perioperative management strategies.