RT Journal Article
SR Electronic
T1 The risk of postoperative pulmonary complications in lung resection candidates with normal FEV1 and DLCO: a prospective multicenter study
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00421-2022
DO 10.1183/23120541.00421-2022
A1 Ivan Cundrle
A1 Zdenek Merta
A1 Monika Bratova
A1 Pavel Homolka
A1 Ladislav Mitas
A1 Vladimir Sramek
A1 Michal Svoboda
A1 Zdenek Chovanec
A1 Milos Chobola
A1 Lyle J. Olson
A1 Kristian Brat
YR 2022
UL http://openres.ersjournals.com/content/early/2022/11/10/23120541.00421-2022.abstract
AB 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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.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.