Reeves Jack M, Bannon Paul, Steffens Daniel, Carey Sharon
Physiotherapy Department, Royal Prince Alfred Hospital, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Cardiothoracic Surgery, Royal Prince Alfred Hospital, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Australia.
Physiotherapy. 2025 Jun;127:101457. doi: 10.1016/j.physio.2024.101457. Epub 2024 Dec 10.
Ventilatory function measured by spirometry is commonly performed preoperatively in people undergoing coronary artery graft surgery (CAGS). Minimal information exists on the associations between spirometry parameters, postoperative pulmonary complications (PPC), and prolonged (≥7 days) length of hospital stay (LOHS) following cardiac surgery. This study aims to investigate the relationships between preoperative spirometry values with both PPC and prolonged LOHS in patients undergoing CAGS, and to compare the predictive value of preoperative spirometry against other known PPC risk factors.
This retrospective observational cohort study analysed patients undergoing preoperative spirometry and CAGS at Royal Prince Alfred Hospital between January 2017 and December 2021. Forced expiratory volume in the first one second (FEV) and forced vital capacity (FVC) were measured. For each patient, both were converted to percentage of predicted value for a healthy person with matched characteristics termed FEV%pred and FVC%pred respectively. The association between FEV%pred and FVC%pred against the incidence of PPC and prolonged LOHS was determined using multivariate logistic regression analysis.
956 patients [773 male, mean (SD): age 65 (10) years; BMI 29 (6)] were analysed. Lower FEV%pred was associated with PPC (odds ratio: 0.99; 95% CI: 0.98 to 0.99, P = 0.009) and prolonged LOHS (odds ratio: 0.99; 95% CI: 0.98 to 0.99, P = 0.003). FVC%pred was not associated with PPC or prolonged LOHS in multivariate analyses.
Preoperative spirometry could be valuable in predicting risk of PPC and prolonged LOHS in people undergoing CAGS and therefore could be useful in identifying at risk patients preoperatively. CONTRIBUTION OF THE PAPER.
通过肺活量测定法测量通气功能通常在接受冠状动脉搭桥手术（CAGS）的患者术前进行。关于肺活量测定参数、术后肺部并发症（PPC）以及心脏手术后延长（≥7天）住院时间（LOHS）之间的关联，现有信息极少。本研究旨在调查接受CAGS患者术前肺活量测定值与PPC和延长LOHS之间的关系，并比较术前肺活量测定相对于其他已知PPC危险因素的预测价值。
这项回顾性观察队列研究分析了2017年1月至2021年12月在皇家阿尔弗雷德王子医院接受术前肺活量测定和CAGS的患者。测量了第1秒用力呼气量（FEV）和用力肺活量（FVC）。对于每位患者，二者分别转换为具有匹配特征的健康人的预测值百分比，分别称为FEV%pred和FVC%pred。使用多因素逻辑回归分析确定FEV%pred和FVC%pred与PPC发生率和延长LOHS之间的关联。
分析了956例患者[773例男性，平均（标准差）：年龄65（10）岁；体重指数29（6）]。较低的FEV%pred与PPC（比值比：0.99；95%置信区间：0.98至0.99，P = 0.009）和延长LOHS（比值比：0.99；95%置信区间：0.98至'99，P = 0.003）相关。在多因素分析中，FVC%pred与PPC或延长LOHS无关。
术前肺活量测定对于预测接受CAGS患者的PPC风险和延长LOHS可能有价值，因此在术前识别高危患者可能有用。论文的贡献。
