Perioperative Lung Function Monitoring for Anatomic Lung Resections

Abstract

The aim of this study was to prospectively investigate the correlation between postoperative spirometry values and pulmonary complications after anatomic lung resections. In addition, we compared postoperative pulmonary function changes between open and minimally invasive approaches. Three hundred eighty-four patients who underwent an anatomic lung resection at our institution between June 2013 and June 2016 were enrolled in this prospective observational trial. Bedside spirometry was performed before surgery and postoperatively every second day until discharge. For the 250 patients who completed the trial, the following data were collected and analyzed: spirometry findings, pain management, surgical procedure, and postoperative complications. A propensity score matched analysis was performed to compare open and minimally invasive approaches. Postoperative pneumonia was significantly more frequent after open surgery (13.2% versus 4.4%, p= 0.016); furthermore, these patients showed significantly greater losses of forced expiratory volume in 1 second on postoperative day 4 compared with patients without pneumonia (loss in percent from preoperative absolute values: 43.2% versus 32,2%, p= 0.013). When focusing on patients without pneumonia, propensity matched analysis revealed a significantly faster recovery of forced expiratory volume in 1 second on postoperative day 4 in the minimally invasive group compared with the open group (p= 0.011). Daily bedside spirometry might be a helpful diagnostic adjunct for early recognition, and hence, timely treatment, of pulmonary infection after open anatomic lung resections. In addition, minimally invasive techniques not only resulted in a lower rate of pulmonary infections but also resulted in faster postoperative recovery of pulmonary function and shorter hospital stay.