Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy

Mark F Berry, Nestor R Villamizar-Ortiz, Betty C Tong, William R Burfeind Jr, David H Harpole, Thomas A D'Amico, Mark W Onaitis, Mark F Berry, Nestor R Villamizar-Ortiz, Betty C Tong, William R Burfeind Jr, David H Harpole, Thomas A D'Amico, Mark W Onaitis

Abstract

Background: Pulmonary function tests predict respiratory complications and mortality after lung resection through thoracotomy. We sought to determine the impact of pulmonary function tests upon complications after thoracoscopic lobectomy.

Methods: A model for morbidity, including published preoperative risk factors and surgical approach, was developed by multivariable logistic regression. All patients who underwent lobectomy for primary lung cancer between December 1999 and October 2007 with preoperative forced expiratory volume in 1 second (FEV1) or diffusion capacity to carbon monoxide (Dlco) 60% or less predicted were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Pulmonary complications were defined as atelectasis requiring bronchoscopy, pneumonia, reintubation, and tracheostomy.

Results: During the study period, 340 patients (median age 67) with Dlco or FEV1 60% or less (mean % predicted FEV1, 55+/-1; mean % predicted Dlco, 61+/-1) underwent lobectomy (173 thoracoscopy, 167 thoracotomy). Operative mortality was 5% (17 patients) and overall morbidity was 48% (164 patients). At least one pulmonary complication occurred in 57 patients (17%). Significant predictors of pulmonary complications by multivariable analysis for all patients included Dlco (odds ratio 1.03, p=0.003), FEV1 (odds ratio 1.04, p=0.003), and thoracotomy as surgical approach (odds ratio 3.46, p=0.0007). When patients were analyzed according to operative approach, Dlco and FEV1 remained significant predictors of pulmonary morbidity for patients undergoing thoracotomy but not thoracoscopy.

Conclusions: In patients with impaired pulmonary function, preoperative pulmonary function tests are predictors of pulmonary complications when lobectomy for lung cancer is performed through thoracotomy but not through thoracoscopy.

Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Incidence of respiratory complications as a function of (a) preoperative FEV1 and (b) preoperative DLCO.
Figure 1
Figure 1
Incidence of respiratory complications as a function of (a) preoperative FEV1 and (b) preoperative DLCO.
Figure 2
Figure 2
Regression lines showing the predicted probability of pulmonary complications as a function of (a) preoperative % predicted FEV1 and (b) preoperative % predicted DLCO for patients undergoing lobectomy via thoracotomy. The shaded areas surrounding the regression line represent 95 percent confidence limits. The circles at the top and bottom of the plots show the actual observed occurrence (top plot line) or lack of occurrence (bottom plot line) of a pulmonary complication and the pulmonary function measurement for each patient in the study.
Figure 2
Figure 2
Regression lines showing the predicted probability of pulmonary complications as a function of (a) preoperative % predicted FEV1 and (b) preoperative % predicted DLCO for patients undergoing lobectomy via thoracotomy. The shaded areas surrounding the regression line represent 95 percent confidence limits. The circles at the top and bottom of the plots show the actual observed occurrence (top plot line) or lack of occurrence (bottom plot line) of a pulmonary complication and the pulmonary function measurement for each patient in the study.
Figure 3
Figure 3
Regression lines showing the predicted probability of pulmonary complications as a function of (a) preoperative % predicted FEV1 and (b) preoperative % predicted DLCO for patients undergoing lobectomy via thoracoscopy. The shaded areas surrounding the regression line represent 95 percent confidence limits. The circles at the top and bottom of the plots show the actual observed occurrence (top plot line) or lack of occurrence (bottom plot line) of a pulmonary complication and the pulmonary function measurement for each patient in the study.
Figure 3
Figure 3
Regression lines showing the predicted probability of pulmonary complications as a function of (a) preoperative % predicted FEV1 and (b) preoperative % predicted DLCO for patients undergoing lobectomy via thoracoscopy. The shaded areas surrounding the regression line represent 95 percent confidence limits. The circles at the top and bottom of the plots show the actual observed occurrence (top plot line) or lack of occurrence (bottom plot line) of a pulmonary complication and the pulmonary function measurement for each patient in the study.

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