Lee Alex Hyunkee, Seyednejad Nazgol, Yang Yuwei, Gilbert Sebastien, Jones Daniel, Maziak Donna E, Sundaresan Ramanadhan S, Villeneuve Patrick J, Seely Andrew J E
Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
J Thorac Dis. 2024 Nov 30;16(11):7574-7581. doi: 10.21037/jtd-24-600. Epub 2024 Nov 13.
Postoperative pulmonary complications (PPCs) represent a significant source of morbidity and mortality in surgical patients. Measurement of predicted postoperative forced expiratory volume in the first second (ppo FEV1) may allow for reliable prediction of PPCs and perioperative planning. This study aimed to determine if impaired ppo FEV1 is associated with increased risk of PPCs following oncologic lung resection.
Patients who underwent elective pulmonary resection at The Ottawa Hospital between 2008 and 2018 were evaluated. The presence and severity of PPCs as defined by the Ottawa Thoracic Morbidity & Mortality system were analyzed. The incidence of PPCs was evaluated based on different ppo FEV1 cut-off values (40%, 50%, and 60%), and a multivariable logistic regression was performed to identify predictors of PPCs.
Of 1,949 included patients, a thoracoscopic approach (64.4%) was most frequently utilized, and lobectomies represented the most common procedure (60.5%). All cut-off ppo FEV1 values of <40% (P<0.001), <50% (P<0.001), and <60% (P=0.004) were associated with more frequent PPCs (13.0%, 11.6%, and 7.6%, respectively), while only ppo FEV1 <50% showed differences in both minor (P<0.001) and major (P=0.005) PPCs. With ppo FEV1 <50%, differences in PPCs were demonstrated specifically in both thoracoscopic (P=0.03) and open (P=0.003) procedures. On multivariable analysis, ppo FEV1 <50% (P=0.03) and need for operative conversion (P<0.001) independently predicted PPCs.
Routine assessment of ppo FEV1 is a practical strategy to identify patients at increased risk of developing PPCs, and can identify candidates for preoperative optimization and postoperative pulmonary support.
术后肺部并发症（PPCs）是外科手术患者发病和死亡的重要原因。测量预计术后第1秒用力呼气量（ppo FEV1）有助于可靠预测PPCs并进行围手术期规划。本研究旨在确定ppo FEV1受损是否与肿瘤性肺切除术后PPCs风险增加相关。
对2008年至2018年期间在渥太华医院接受择期肺切除术的患者进行评估。分析渥太华胸科发病率和死亡率系统定义的PPCs的存在情况和严重程度。根据不同的ppo FEV1临界值（40%、50%和60%）评估PPCs的发生率，并进行多变量逻辑回归以确定PPCs的预测因素。
在纳入的1949例患者中，最常采用胸腔镜手术（64.4%），肺叶切除术是最常见的手术方式（60.5%）。所有ppo FEV1临界值<40%（P<0.001）、<50%（P<0.001）和<60%（P=0.004）均与更频繁的PPCs相关（分别为13.0%、11.6%和7.6%），而只有ppo FEV1<50%在轻度（P<0.001）和重度（P=0.005）PPCs中均显示出差异。当ppo FEV1<50%时，PPCs的差异在胸腔镜手术（P=0.03）和开放手术（P=0.003）中均有体现。多变量分析显示，ppo FEV1<50%（P=0.03）和需要转为开胸手术（P<0.001）可独立预测PPCs。
常规评估ppo FEV1是识别发生PPCs风险增加患者的实用策略，并且可以识别术前优化和术后肺部支持的候选者。
