The value of preoperative spirometry testing for predicting postoperative risk in upper abdominal and thoracic surgery assessed using big-data analysis.

BACKGROUND

Spirometry is used to evaluate postoperative outcomes in thoracic surgery. However, the clinical utility of spirometry for predicting postoperative complications has not been determined. We used big-data analysis to examine the relationship between pulmonary function tests and postoperative complications.

METHODS

We retrospectively analysed clinical data from 31,827 patients who underwent spirometry within the 3 months prior to their surgery between January 2000 and December 2014 at a single tertiary referral hospital. The data were extracted in de-identified form via the automated clinical research information system. Surgical procedures included thoracic and upper abdominal surgery.

RESULTS

Multivariable logistic regression analysis showed that type of surgery, older age (>65 years), low albumin and smoking were associated with postoperative infections [95% confidence interval (CI) of the odds ratio (OR) 1.27-1.60 (>65 years); 1.52-1.96 (low albumin); 1.40-1.98 (current smoker)]. Notably, lower forced vital capacity (FVC) was an independent risk factor for postoperative infection, prolonged intensive care unit stay, and in-hospital death, regardless of airflow limitation [OR 95% CI: 1.31-1.69 (FVC 50-80%); 2.02-4.24 (FVC <50%)]. Lower forced expiratory volume in 1 sec (FEV) was also an independent risk factor for postoperative infection [OR 95% CI: 1.61-2.26 (FEV 50-80%); 2.27-4.21 (FEV <50%)]. Airflow limitation assessed by FEV was negatively correlated with postoperative infection in multivariable analysis (OR 95% CI: 0.51-0.88).

CONCLUSIONS

Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.