Lung function tests, exercise capacity and postoperative outcomes of patients with pulmonary resections

Abstract

Abstract Aim: Postoperative complications, especially pulmonary complications, are described after lung resections, with different risk factors involved. We evaluate the relationship between lung function, exercise test parameters and the occurrence of postoperative outcomes in patients with pulmonary resections. Methods: A 5 years prospective observational study on patients with lung resection (lobectomy, bilobectomy and pneumonectomy) for lung cancer and other pulmonary pathologies has been performed. All the patients were preoperatively evaluated using spirometry, plethysmography, diffusing capacity test and cardio-pulmonary exercise test (CPET). Data were analysed regarding the linkage between cardiopulmonary fitness and postoperative outcomes (respiratory complications and 90-day mortality). Results: Of 155 consecutive patients (109 male, mean age 61.2 ± 9.8 years), 130 (83.9%) underwent pulmonary resection for lung cancer. Nearly 24% of patients developed postoperative respiratory complications (mainly atelectasis, prolonged air leak and respiratory failure). The 90-day mortality was 5.2%. A reduced absolute value of forced expiratory volume in 1 s (FEV1) was found to be associated with postoperative atelectasis [odds ratio (OR) 0.33; 95% confidence interval (CI) 0.11–0.99], but with low accuracy. The most related variable and a predictor to prolonged air leak was FEV1/vital capacity (VC) ratio (OR 0.90; 95% CI 0.83–0.99). Patients who developed respiratory failure had lower values of static volumes and breathing reserve (BR%) compared to those without respiratory failure, but with no significant difference (P > 0.050). No relationship to mortality was noted. Conclusion: In our study group, lower values of FEV1 were related to postoperative atelectasis and obstructive dysfunction with persistent air leak, with no significant association with mortality.