Evaluation Of Surgical Risk Research Articles

Which factors are associated with adverse prognosis in multiple myeloma patients after surgery? - preliminary establishment and validation of the nomogram

BackgroundTo investigate the prognosis of patients with Multiple Myeloma (MM) after surgery, analyze the risk factors leading to adverse postoperative outcomes, and establish a nomogram.MethodsClinical data from 154 patients with MM who underwent surgery at our institution between 2007 and 2019 were retrospectively analyzed. Assessing and comparing patients’ pain levels, quality of life, and functional status before and after surgery (P < 0.05) were considered statistically significant. The Kaplan-Meier survival curve was used to estimate the median survival time. Adverse postoperative outcomes were defined as worsened symptoms, lesion recurrence, complication grade ≥ 2, or a postoperative survival period < 1 year. Logistic regression analysis was used to determine the prognostic factors. Based on the logistic regression results, a nomogram predictive model was developed and calibrated.ResultsPostoperative pain was significantly alleviated in patients with MM, and there were significant improvements in the quality of life and functional status (P < 0.05). The median postoperative survival was 41 months. Forty-nine patients (31.8%) experienced adverse postoperative outcomes. Multivariate logistic regression analysis identified patient age, duration of MM, International Staging System, preoperative Karnofsky Performance Status, and Hb < 90 g/L as independent factors influencing patient prognosis. Based on these results, a nomogram was constructed, with a C-index of 0.812. The calibration curve demonstrated similarity between the predicted and actual survival curves. Decision curve analysis favored the predictive value of the model at high-risk thresholds from 10% to-69%.ConclusionThis study developed a nomogram risk prediction model to assist in providing quantifiable assessment indicators for preoperative evaluation of surgical risk.

Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.

Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option.

Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low surgical risk and intermediate surgical risk populations. Consequently, in this setting, some aspects acquire greater relevance: surgical risk evaluation, clinical assessment, multimodality imaging of the valve, and management of coronary artery disease. Moreover, future issues such as coronary artery re-access and valve-in-valve interventions should be considered in the valve selection process. This review aims to summarize the principal aspects of a multidimensional (multidisciplinary) and comprehensive preprocedural work-up. The Heart Team is at the center of the decision-making process of the management of aortic valve disease and bears responsibility for offering each patient a tailored approach based on an individual evaluation of technical aspects together with the risks and benefits of each modality. Considering the progressive expansion in TAVI indication and technological progress, the role of a work-up and multidisciplinary Heart Team will be even more relevant.

Surgical treatment for active infective endocarditis: progress and challenges

<p indent=0mm>Infective endocarditis (IE) is a challenging disease. In the past century, it has the highest mortality among all kinds of valvular heart diseases. Treatment for IE has developed over time from anti-infective therapy only to today’s active surgery. However, due to its characteristics of multisystem involvement and changeable clinical symptoms, early diagnosis, indication and timing of surgery, and evaluation of surgical risk remain urgent issues at present. By reviewing representative literature in the past <sc>20 years</sc> and combining them with our experience of surgical treatment for IE, we summarize the latest progress and challenges faced by active surgery for IE, and emphasize the importance of establishing IE multidisciplinary team in clinical practice.

Association between frailty and self-reported health following heart valve surgery.

BackgroundKnowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery.MethodsIn a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L).To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI).ResultsFrailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51–7.52), VAS 2.41 (1.13–5.14), and KCCQ 2.84 (1.35–5.97).ConclusionFrailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk.

Employment status before and after open heart valve surgery: A cohort study.

Detachment from the workforce following open heart valve surgery is a burden for the patient and society. The objectives were to examine patterns of employment status at different time points and to investigate factors associated with a lower likelihood of returning to the workforce within six months. A cohort study of patients aged 18-63 undergoing valvular surgery at a Danish tertiary centre from 2013-2017. Return to the workforce was defined as being employed, unemployed (still capable of working) or receiving paid leave of absence. The association between demographic-, clinical characteristics (including a surgical risk evaluation, EuroScore), and return to the workforce were investigated with a multivariable logistic regression model. In total, 1,395 consecutive patients underwent surgery, 347 were between 18 and 63 years and eligible for inclusion. Of those, 282 were attached to the workforce before surgery and included in the study. At the time of surgery, 79% were on paid sick leave. After six months, 21% of the patients (being part of the workforce before surgery), were still on sick leave. In the regression model, prolonged sick leave prior to surgery (OR 0.43, 95% CI 0.23-0.79) and EuroScore ≥ 2.3 (OR 0.39, 95% CI 0.21-0.74) significantly reduced the likelihood of returning to the workforce. One-fifth of patients in the working-age were on sick leave six months after surgery. Prolonged sick leave prior to surgery and a EuroScore ≥2.3 were associated with a lower likelihood of returning to the workforce.

The Surgical Strategies and Techniques of Transorbital Nonmissile Brain Injury

This study aimed to summarize the experience with the management of transorbital brain injury (TOBI) at our institution that may help inform surgical decision-making. Four adults with TOBIs were admitted to our hospital and received surgical treatment. The patients' clinical manifestations, physical findings, imaging data, surgical treatment, and postoperative outcome were prospectively collected and subject to retrospective analysis. All patients were male. In 2 patients, the entry point of the cranium was the superior orbital fissure, whereas in the other 2, the entry point was the orbital roof. Thorough physical examination and comprehensive diagnostic imaging were performed preoperatively in all patients for careful assessment of the foreign body and its surrounding important structures. In collaboration with our multidisciplinary trauma team, individualized surgeries were successfully designed and performed in the 4 patients to remove the foreign bodies along the path of their trajectories. Three patients had uneventful postoperative courses, whereas 1 patient died because of severe cerebral ischemia and refractory brain swelling after decompressive craniectomy. A comprehensive understanding of the regional anatomy of the trajectory is the cornerstone for surgical management of TOBIs. Adequate preoperative imaging examinations are essential for the evaluation of surgical risks and for making a tailored management strategy. Early surgical exploration through multidisciplinary collaboration is highly recommended for achieving a favorable outcome.

Evaluating Surgical Risk Using FMEA and MULTIMOORA Methods under a Single-Valued Trapezoidal Neutrosophic Environment.

BackgroundHuman errors during operations may seriously threaten patient recovery and safety and affect the doctor–patient relationship. Therefore, risk evaluation of the surgical process is critical. Risk evaluation by failure mode and effect analysis (FMEA) is a prospective technology that can identify and evaluate potential failure modes in the surgical process to ensure surgical quality and patient safety. In this study, a hybrid surgical risk–evaluation model was proposed using FMEA and multiobjective optimization on the basis of ratio analysis plus full multiplicative form (MULTIMOORA) method under a single-valued trapezoidal neutrosophic environment. This work aimed to determine the most critical risk points during the surgical process and analyze corresponding solutions.MethodsA team for FMEA was established from domain experts from different departments in a hospital in Hunan Province. Single-valued trapezoidal neutrosophic numbers (SVTNNs) were used to evaluate potential risk factors in the surgical process. Cmprehensive weights combining subjective and objective weights were determined by the best–worst method and entropy method to differentiate the importance of risk factors. The SVTNN–MULTIMOORA method was utilized to calculate the risk-priority order of failure modes in a surgical process.ResultsThe hybrid FMEA model under the SVTNN–MULTIMOORA method was used to calculate the ranking of severity of 21 failure modes in the surgical process. An unclear diagnosis is the most critical failure in the surgical process of a hospital in Hunan Province.ConclusionThe proposed model can identify and evaluate the most critical potential failure modes of the surgical process effectively. In addition, such a model can help hospitals to reduce surgical risk and improve the safety of surgery.

MP57-05 LOW FREE TESTOSTERONE AND FRAILTY PREDICT OVERALL SURVIVAL IN SURGICAL PATIENTS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP57)1 Apr 2020MP57-05 LOW FREE TESTOSTERONE AND FRAILTY PREDICT OVERALL SURVIVAL IN SURGICAL PATIENTS Fangyi Lin*, Gordon Hong, Frances Kim, Farha Pirani, Salima Makhani, Mark Henry, Ian Cooke, Reza Nabavizadeh, Chad W. M. Ritenour, Mehrdad Alemozaffar, Viraj A. Master, and Kenneth Ogan Fangyi Lin*Fangyi Lin* More articles by this author , Gordon HongGordon Hong More articles by this author , Frances KimFrances Kim More articles by this author , Farha PiraniFarha Pirani More articles by this author , Salima MakhaniSalima Makhani More articles by this author , Mark HenryMark Henry More articles by this author , Ian CookeIan Cooke More articles by this author , Reza NabavizadehReza Nabavizadeh More articles by this author , Chad W. M. RitenourChad W. M. Ritenour More articles by this author , Mehrdad AlemozaffarMehrdad Alemozaffar More articles by this author , Viraj A. MasterViraj A. Master More articles by this author , and Kenneth OganKenneth Ogan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000926.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is a prevalent syndrome of decreased resiliency and physiologic reserves. Preoperative frailty has been predictive of higher complications and mortality. Low testosterone (TS) has been associated with physical and cognitive decline. We hypothesize that low TS levels will be associated with frailty and be a predictor of postoperative outcomes in patients undergoing surgery. METHODS: This study included 136 male patients undergoing major surgery from 2014-2019. Frailty was assessed by the widely used Fried criteria with a score ≥2 categorized as frail. Total and free TS were obtained pre-operatively. A 4-level composite scoring system was used to assess the combined effect of frailty and age-adjusted free TS on postoperative outcomes. Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model to identify clinical factors associated with overall survival (OS). RESULTS: Mean age of the cohort was 62 ±10 years, and a total of 15 deaths occurred over a median follow-up period of 106 weeks. Of the 136 patients, 31 (23%) were frail, and 55 (40%) had low levels of age-adjusted free TS. In univariate analyses, low free TS was associated with frailty (p<0.001) and frailty was predictive of OS (p<0.001). When combined, frailty and low free TS also independently predicted survival in univariate analyses (p=0.04). Multivariate analysis revealed that the composite score was the only significant pre-operative predictor of OS. Kaplan-Meier survival curves revealed an overall difference in survival among the composite frailty and TS groups (log rank p=0.02), and frail patients with low free TS had over a 6-fold risk of death compared to non-frail patients with normal TS levels (HR 6.59; 95% CI 1.56–27.85; p=0.01). CONCLUSIONS: While preoperative frailty alone is correlated with overall survival, we found that the addition of low free TS has greater potential to predict patients at higher risk for decreased overall survival. Free TS may serve as a biomarker to complement current frailty measurements for surgical risk evaluation. Future studies to evaluate TS replacement to reduce such risk in frail patients would be warranted. Source of Funding: John Robinson Churchill family foundation support gratefully acknowledged © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e859-e859 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fangyi Lin* More articles by this author Gordon Hong More articles by this author Frances Kim More articles by this author Farha Pirani More articles by this author Salima Makhani More articles by this author Mark Henry More articles by this author Ian Cooke More articles by this author Reza Nabavizadeh More articles by this author Chad W. M. Ritenour More articles by this author Mehrdad Alemozaffar More articles by this author Viraj A. Master More articles by this author Kenneth Ogan More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative evaluation by functional magnetic resonance imaging in patients with dysembryoplastic neuroepithelial tumours: A case series

IntroductionDysembryoplastic neuroepithelial tumours (DNET) are a type of benign glioneuronal neoplasia of typically temporal location that produce drug-resistant epileptic seizures in children and young adults. AimsThis work aims to assess the usefulness of functional magnetic resonance imaging (fMRI) in the preoperative study in four patients with DNET. A Philips Intera 3.0 Tesla magnetic resonance imaging scanner and the Blood-Oxygen-Level-Dependent (BOLD) technique were used to obtain the images, making it possible to locate the eloquent areas for language and motor areas through the application of specific paradigms. ResultsIn one case the tumour was adjacent to Broca’s area, in two cases it coincided with Wernicke’s area, in one patient it was <1 cm from the motor area for the hand and in another close to memory. Only two of the patients were operated on, without postoperative functional deficit. Hemispheric activation contralateral to the tumour suggestive of neuroplasticity was observed in one of the patients. ConclusionsfMRI is a non-invasive method that allows us to assess the proximity of lesions to eloquent areas, which is key in the evaluation of surgical risk. In addition, it allowed the detection of probable neuroplasticity in one case, which guaranteed the success of the surgery

Evaluation of surgical risk and prognosis between thyroid nodules of size

The objective of this study was to evaluate the surgical risk and prognosis between thyroid nodules of size <1 and ≥1 cm and to explore whether it is reasonable generally to ignore the diagnosis and treatment of thyroid nodules and thyroid carcinoma <1 cm in wide areas of China. A retrospective observational study included all first-time thyroid surgery patients between January 2005 and December 2016 of the First Affiliated Hospital of Harbin Medical University. All patients were divided into two groups (group A: <1 cm, group B: ≥1 cm) according to the maximum diameter of the nodules and demographics, surgery procedure, pathology, postoperative complications, morbidity, and mortality were analyzed. A total of 6,317 patients were reviewed and 3,424 (54.20%) of them were malignant; 2,128 patients in group A and 4,189 in group B. Patients in group A had better pathological diagnosis, inferior extent of lymph node metastasis, less surgical complexity, fewer postoperative complications, and longer disease-free survival (DFS). Thyroid operations were safer and involved fewer postoperative complications when thyroid nodules were <1 cm and patients who were diagnosed with malignant thyroid disease had superior prognoses. Underdeveloped regions of China should diagnose and treat thyroid nodules <1 cm early.

Evaluation of Surgical Risk

In assessing surgical risk, appropriate preoperative evaluation should systematically address a patient's pre-existing medical conditions and identifies unrecognized comorbidities, ideally leading to the anticipation and treatment of potential complications both pre- and postoperation. Thus, a thorough evaluation of the patient history and physical examination is essential. Various risk assessments discussed in this review are those for cardiac, pulmonary, renal, hepatic, and hematologic concerns. Cardiac risk assessment focuses on patient-related risk factors, including coronary artery disease, congestive heart failure, valvular heart disease, arrhythmias and conduction defects, implanted pacemakers and implantable cardiac defibrillators, cardiomyopathy, and hypertension. The pulmonary patient-related risk factors are explored and include age and general health status, smoking, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, obesity, pulmonary hypertension, and heart failure. Preoperative medication management is also explored. This review contains 3 figures, 31 tables, and 75 references. Key words: surgical risk calculators, cardiac complications, coronary artery disease, hypertension, perioperative, cardiac risk assessment, preoperative evaluation

Evaluation of Surgical Risk

Evaluation of Surgical Risk

Evaluation of Surgical Risk

Evaluation of Surgical Risk

Diagnosis of Invasive Nonfunctional Pituitary Adenomas by Serum Extracellular Vesicles.

The invasiveness evaluation of nonfunctional pituitary adenoma (NFPAs) is crucial for the prediction of the malignant potential and for making surgical plans of NFPAs. Current invasiveness evaluation of NFPAs is based on neuroimaging, which can hardly predict the invasive potential and dynamically monitor disease progress. Here we used microbead-assisted flow cytometry to detect and analyze the serum extracellular vesicles (EVs) from 30 NFPAs patients (15 invasive and 15 noninvasive). Lower expressions of folate receptor 1 (FOLR1) and epithelial cell adhesion molecule (EpCAM) were found in serum EVs from the invasive NFPAs patients compared to the noninvasive ones [area under the curve (AUC) of 0.94 for FOLR1 and 0.88 for EpCAM]. Meanwhile, increased mRNA expression of vimentin and N-cadherin, two mesenchymal markers, was found in serum EVs from the invasive NFPAs patients compared to the noninvasive ones. Consistent results were observed in the tumor tissue that invasive NFPAs have lower expression of the epithelial markers while higher expression of the mesenchymal markers. These results suggested the possible role of epithelial-mesenchymal transition (EMT) in the invasiveness of NFPAs. Pituitary tumor transforming gene 1 (PTTG1) mRNA in serum EVs was also found to be an indicator for invasive NFPAs and is related with EMT. These results provide a method for the blood-based diagnosis and invasiveness evaluation of NFPAs and would be beneficial to the diagnosis, prognosis prediction, and surgical risk evaluation of NFPAs.

Analysis of survival for lung cancer resections cases with fuzzy and soft set theory in surgical decision making.

ObjectiveLung cancer is the most common type of cancer around the world, and it represents the main cause of death in the USA. Surgical treatment is the optimal therapeutic strategy for resectable non-small cell lung cancer. The principal factor for long-term survival after complete resection is the anatomic extension of the neoplasm. However, other factors also have adverse effects on operative mortality, and influence long-term outcome. In this paper we propose an algorithmic solution for the estimation of 5-years survival rate in lung cancer patients undertaking pulmonary resection.Materials and methodsWe address the issue of survival analysis through decision-making techniques based on fuzzy and soft set theories. We develop an expert system based on clinical and functional data of lung cancer resections in patients with cancer that can be used to predict the survival of patients.ResultsThe evaluation of surgical risk in patients undertaking pulmonary resection is a primary target for thoracic surgeons. Lung cancer survival is influenced by many factors. The computational performance of our algorithm is critically analyzed by an experimental study. The correct survival classification is achieved with an accuracy of 79.0%. Our novel soft-set based criterion is an effective and precise diagnosis application for the determination of the survival rate.

Man against the machine - Differences in surgical risk evaluation. A cohort prospective study

BackgroundThe aim of this study was to compare the assessment provided by the ACS Surgical Risk Calculator with the assessments provided by senior and resident anesthesiologists. MethodsThe study is prospective and controlled. Before the surgical procedure a resident anesthesiologist collected data needed to perform pre-operative assessment. Then, based on this data, a risk assessment was carried out by resident and senior anesthesiologists and by the online ACS Surgical Risk Calculator. Then the three evaluations were compared. Demographic and clinical data were gathered to determine risk factors and complication rates. ResultsOne hundred patients who were scheduled for a surgical procedure were recruited for the study. A difference was found among the different estimations. In most parameters the resident anesthesiologists more resembled the ACS assessment than the senior anesthesiologists. The following differences in risk assessment were found: possible complication in the course of the surgery (4.4% ACS calculator, 1% senior anesthesiologists, 2.2% resident anesthesiologists), and for a life-threatening complication (3.6% ACS calculator, 0.5% senior anesthesiologists, 2.4% resident anesthesiologists). In assessing death, urinary tract and surgical sites infections the seniors difference to the ACS calculator was statistically significant (p < 0.05). Seniors resembled better cardiac complications (p < 0.05) and both resident and senior anesthesiologists failed to resemble the ACS calculator in assessing return to the operating room and pneumonia (p < 0.05). ConclusionsBoth senior and resident anesthesiologists failed to estimate the surgical risks based on preoperative data. Further study involving the surgeons and comparing the estimated to the actual complication rates are needed.

Morbid Obesity

Recent statistics indicate that the obesity rate exceeds 35% in 5 states and 30% in 25 states in the United States. As the prevalence of obesity continues to increase, the number of bariatric and nonbariatric surgeries in this patient population also continues to grow. As such, anesthesia providers must be cognizant of some special considerations pertaining to surgery and anesthesia for the obese patient. Overall, surgery on obese patients is considered higher risk than in nonobese patients, and targeted perioperative assessment and planning are crucial for reducing morbidity and mortality. Obesity results in alterations in physiology, and these effects are seen within all major organ systems. Extra consideration should be dedicated not only to the preoperative airway evaluation but also to logistic issues that may arise. To this end, it is crucial that the operating room be equipped with size-appropriate equipment as well as allowing for adequate time to move, position, and induce obese patients. Intraoperative concerns due to obesity include appropriate drug dosing, choice of anesthetic, and the cardiopulmonary impact of the anesthetic. Postoperative concerns include pain control, pulmonary hygiene maneuvers, as well as continued management of comorbid conditions. These alterations and their impact on the perioperative care of an obese patient at various points of perioperative care are herein reviewed. This review contains 2 figures, 5 tables and 36 references Key Words: airway evaluation, body mass index, drug dosing, morbid obesity, obesity hypoventilation syndrome, preoperative evaluation, rapid desaturation, sleep apnea evaluation, surgical risk evaluation

Preoperative evaluation of the elderly surgical patient and anesthesia challenges in the XXI century.

Universally recognized goals of preoperative anesthesia assessment are the evaluation of patient's health status to define the entity of the surgical risk, and the anticipation of possible complications while optimizing and planning preventive strategies. Data obtained by Comprehensive Geriatric Assessment (CGA) and frailty evaluation are of extreme usefulness in surgical risk evaluation in older patients and in the decision about surgery. It is from the team-based discussion of such results that the most appropriate treatment can be individuated, surgery invasiveness and duration critically analyzed and if needed modified, and the best perioperative strategy carefully tailored. These data should thus be used as reference points not only in preoperative assessment but also in planning the perioperative course, from pre-habilitation to adequate intraoperative management to complications prevention and care continuity after discharge. It is from such a far-seeing approach that issues emerged from preoperative evaluation can really contribute to decision-making about surgery in the elderly.

Surgical risk evaluation of lung cancer in COPD patients – A cohort observational study

Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test.This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%).Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p=0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%.This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery.