Lee Bora, Ji Wonjun, Lee Sei Won, Choi Chang-Min, Oh Yeon-Mok, Lee Jae Seung
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Thorac Dis. 2024 Oct 31;16(10):6595-6603. doi: 10.21037/jtd-24-138. Epub 2024 Oct 17.
Chronic obstructive pulmonary disease (COPD) is a well-known risk factor for postoperative pulmonary complications (PPCs), necessitating careful preoperative evaluation in patients undergoing lung resection surgery. The risk of PPCs in patients with COPD may vary with severity of symptoms, and the COPD Assessment Test (CAT) score is commonly used to assess patient quality of life and predict acute exacerbations. However, few studies have explored the correlation between CAT score and PPC incidence in COPD. This study aimed to assess the predictive value of CAT scores for PPCs and compare them with other established PPC predictors in mild to moderate COPD.
We retrospectively reviewed 83 patients with COPD who underwent preoperative evaluation before lung cancer surgery, including cardiopulmonary exercise tests (CPETs), between January 2020 and June 2022. We compared the predictive value of the following factors for the incidence of PPCs: spirometry, CPETs, 6-min walk tests, symptom-based scores (including CAT scores), the COPD composite severity index, surgery type, comorbidity index, and PPC prediction models.
Among the 83 patients, 16 (19.2%) developed PPCs, with persistent air leakage being the most common complication. CAT scores significantly differed between PPC and non-PPC groups (mean value 9.4 . 6.7, P=0.002). In multivariable logistic regression analysis, a CAT score of ≥7 was an independent risk factor for the incidence of PPCs (odds ratio =9.88; 95% confidence interval: 1.95-50.04; P=0.005), whereas other factors demonstrated no significant predictive value.
CAT scores are valuable for evaluating patients with mild to moderate COPD before lung resection surgery, reliably predicting PPCs.
慢性阻塞性肺疾病（COPD）是术后肺部并发症（PPC）的一个众所周知的危险因素，因此在接受肺切除手术的患者中需要进行仔细的术前评估。COPD患者发生PPC的风险可能因症状严重程度而异，COPD评估测试（CAT）评分通常用于评估患者的生活质量并预测急性加重。然而，很少有研究探讨CAT评分与COPD患者PPC发生率之间的相关性。本研究旨在评估CAT评分对PPC的预测价值，并将其与其他已确立的轻度至中度COPD患者PPC预测指标进行比较。
我们回顾性分析了2020年1月至2022年6月期间83例在肺癌手术前接受包括心肺运动试验（CPET）在内的术前评估的COPD患者。我们比较了以下因素对PPC发生率的预测价值：肺功能测定、CPET、6分钟步行试验、基于症状的评分（包括CAT评分）、COPD综合严重指数、手术类型、合并症指数和PPC预测模型。
83例患者中，16例（19.2%）发生了PPC，持续性漏气是最常见的并发症。PPC组和非PPC组的CAT评分有显著差异（平均值9.4对6.7，P=0.002）。在多变量逻辑回归分析中，CAT评分≥7是PPC发生率的独立危险因素（比值比=9.88；95%置信区间：1.95-50.04；P=0.005），而其他因素未显示出显著的预测价值。
CAT评分对于在肺切除手术前评估轻度至中度COPD患者很有价值，能够可靠地预测PPC。
