Towe Christopher W, Badrinathan Avanti, Khil Alina, Alvarado Christine E, Ho Vanessa P, Bassiri Aria, Linden Philip A
Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5011, USA.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241305954. doi: 10.1177/17534666241305954.
Guidelines advocate pulmonary function testing (PFT) in preoperative evaluation before lung resection. Although forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO) are recommended, they are often poor predictors of complications.
Determine if PFT testing results other than FEV1 and DLCO are associated with post-operative complications. We hypothesized that other PFT test results may improve the prediction of post-operative complications.
Retrospective cohort study of a single institution.
We analyzed patients who underwent anatomic lung resections from 1/2007 to 1/2017. Percent predicted post-operative (ppo) PFT values were calculated for each test result. Outcome of interest was any post-operative complication. Wilcoxon rank-sum and multivariable regression were used to determine the relationship of PFT results to post-operative complications.
We analyzed 922 patients who underwent anatomic lung resections. Complications occurred in 240 (26.0%) patients, and mortality occurred in 12 (1.3%) patients. In univariate analysis, predicted and percent predicted post-operative (ppo) forced vital capacity (FVC), FEV1, FEF2575, DLCO, DLCO/VA, and VC values were predictors of post-operative complications. Multivariable logistic regression found no independent relationship of test results to post-operative complications, likely reflecting the collinearity of PFT results.
Our findings suggest that non-traditional PFTs, such as FVC, may enhance risk stratification for post-operative complications following anatomic lung resection. Notably, traditional parameters like FEV1 and DLCO were not independently predictive, highlighting the need to reconsider their role in isolation. These findings highlight the need to reconsider how PFT are used in surgical risk stratification given high levels of collinearity.
指南提倡在肺切除术前评估中进行肺功能测试（PFT）。尽管推荐了1秒用力呼气量（FEV1）和肺一氧化碳弥散量（DLCO），但它们往往不能很好地预测并发症。
确定除FEV1和DLCO之外的PFT测试结果是否与术后并发症相关。我们假设其他PFT测试结果可能会改善对术后并发症的预测。
对单一机构进行的回顾性队列研究。
我们分析了2007年1月至2017年1月期间接受解剖性肺切除术的患者。计算每个测试结果的术后预测百分比（ppo）PFT值。感兴趣的结果是任何术后并发症。采用Wilcoxon秩和检验和多变量回归分析来确定PFT结果与术后并发症之间的关系。
我们分析了922例接受解剖性肺切除术的患者。240例（26.0%）患者发生并发症，12例（1.3%）患者死亡。在单变量分析中，预测的和术后预测百分比（ppo）的用力肺活量（FVC）、FEV1、FEF2575、DLCO、DLCO/VA和VC值是术后并发症的预测指标。多变量逻辑回归分析发现测试结果与术后并发症之间没有独立关系，这可能反映了PFT结果的共线性。
我们的研究结果表明，非传统的PFT，如FVC，可能会增强解剖性肺切除术后并发症的风险分层。值得注意的是，像FEV1和DLCO这样的传统参数并不能独立预测，这凸显了需要重新考虑它们单独的作用。鉴于高度的共线性，这些发现强调了需要重新考虑PFT在手术风险分层中的应用方式。
