Prior studies have noted that patients with interstitial lung disease(ILD) possess an increased incidence of lung cancer and risk of postoperative respiratory failure and mortality. We sought to understand the impact of ILD on national-scale outcomes of lung resection.
A retrospective cohort analysis using the STS General Thoracic Surgery Database was conducted on patients who underwent a pulmonary resection for non-small cell lung cancer between 2009-2019. Baseline characteristics and postoperative outcomes were compared between patients with and without ILD (defined as interstitial fibrosis based on clinical, radiographic, or pathological evidence.) Multivariable logistic regression models identified risk factors associated with postoperative mortality, acute respiratory distress syndrome (ARDS), and composite morbidity and mortality.
ILD was documented in 1.5% (1,873/128,723) of patients who underwent a pulmonary resection for non-small cell lung cancer. Patients with ILD were more likely to smoke (90% vs 85%, p<0.001), have pulmonary hypertension (6% vs 1.7%, p<0.001), impaired DLCO (DLCO 40-75%: 64% vs 51%; DLCO<40%: 11% vs 4%, p<0.001), and underwent more sublobar resections (34% vs 23%, p<0.001) compared to patients without ILD. Patients with ILD had increased postoperative mortality (5.1% vs 1.2%, p<0.001), ARDS (1.9% vs 0.5%, p<0.001), and composite morbidity and mortality (13.2% vs 7.4%, p<0.001). ILD remained a strong predictor of mortality (OR 3.94 [3.09-5.01], p<0.001) even when adjusted for patient comorbidities, pulmonary function, extent of resection, and center volume effects.
ILD is a risk factor for operative mortality and morbidity after lung cancer resection, even in patients with normal pulmonary function.

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