The risk of postoperative pulmonary complications in lung resection candidates with normal FEV1 and DLCO: a prospective multicenter study
- Ivan Cundrle1,2,3,
- Zdenek Merta2,4,
- Monika Bratova2,4,
- Pavel Homolka3,5,
- Ladislav Mitas2,6,
- Vladimir Sramek1,2,
- Michal Svoboda2,7,
- Zdenek Chovanec2,3,8,
- Milos Chobola1,2,3,
- Lyle J. Olson9 and
- Kristian Brat2,3,4⇑
- 1Department of Anesthesiology and Intensive Care, St. Anne's University Hospital, Brno, Czech Republic
- 2Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 3International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
- 4Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
- 5Department of Sports Medicine and Rehabilitation, St. Anne's University Hospital, Brno, Czech Republic
- 6Department of Surgery, University Hospital Brno, Brno, Czech Republic
- 7Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
- 8First Department of Surgery, St. Anne's University Hospital, Brno, Czech Republic
- 9Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Corresponding author: Kristian Brat (Brat.Kristian{at}fnbrno.cz)
Abstract
Introduction According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in the first second (FEV1) and diffusing capacity for carbon monoxide (DLCO) are at low risk for postoperative pulmonary complications (PPC). However, PPC affect hospital length of stay and related health care costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV1 and DLCO (>80% predicted) and identify factors associated with PPC.
Methods Three hundred and ninety-eight patients were prospectively studied at 2 centers between 2017 and 2021. PPC were recorded from the first 30 post-operative days. Subgroups of patients with and without PPC were compared and factors with significant difference were analyzed by uni- and multivariate logistic regression.
Results One hundred and eighty-eight subjects had normal FEV1 and DLCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (PETCO2) at rest (27.7 versus 29.9; p=0.033) and higher ventilatory efficiency (VE/VCO2) slope (31.1 versus 28; p=0.016) compared to those without PPC. Multivariate models showed association between rest PETCO2 (OR 0.872; p=0.035) and VE/VCO2 slope (OR 1.116; p=0.03) and PPC. In both models, thoracotomy was strongly associated with PPC (OR 6.419; p=0.005 and OR 5.884; p=0.007, respectively). Peak oxygen consumption failed to predict PPC (p=0.917).
Conclusions Rest PETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and DLCO. We propose rest PETCO2 be an additional parameter to FEV1 and DLCO for preoperative risk stratification.
Footnotes
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Conflict of interests: Kristian Brat received lecture and consulting fees from Chiesi CZ, Boehringer Ingelheim CZ, Novartis CZ, AstraZeneca CZ and Angelini CZ outside the submitted work.
Conflict of interests: Monika Bratova received lecture and fees from Roche CZ, Bristol-Myers Squibb CZ and MSD CZ outside the submitted work.
Conflict of interests: The other authors (Ivan Cundrle Jr, Pavel Homolka, Milos Chobola, Vladimir Sramek, Zdenek Merta, Ladislav Mitas, Michal Svoboda, Zdenek Chovanec and Lyle J Olson) have nothing to disclose.
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- Received August 29, 2022.
- Accepted November 2, 2022.
- Copyright ©The authors 2022
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