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Predictors of exercise oxygen desaturation following major lung resection
Alessandro Brunelli1, Majed Al Refai, Marco Monteverde
1Unit of Thoracic Surgery, Department of Respiratory Diseases, Umberto I Hospital, Ancona, Italy. alexit_2000@yahoo.com
Objective:
To identify predictors of postoperative exercise oxygen desaturation (EOD) in patients submitted to lobectomy or pneumonectomy for lung carcinoma.
Patients And Methods:
A consecutive series of 227 patients with non-small cell lung cancer submitted to lobectomy or pneumonectomy from January 2000 through October 2002 were prospectively analyzed. Maximal stair-climbing tests were performed preoperatively (the day before the operation) and postoperatively (on average, 9.2 days after operation) in room air for all patients. A fall in oxygen saturation during the exercise below 90% was termed 'desaturation'. Univariate and multivariate analyses were performed to identify predictors of postoperative EOD.
Results:
Thirty-five patients (15.4%) developed postoperative EOD. After multivariate analysis, the only independent predictor of postoperative EOD resulted a reduction in oxygen saturation during the preoperative exercise (P=0.0004).
Conclusions:
Patients with a reduction in oxygen saturation during the preoperative exercise test are at increased risk to develop a postoperative EOD below 90%. A postoperative exercise test should be performed in all these patients. Should EOD be confirmed, an intermittent home oxygen therapy is recommended in order to facilitate recovery from operation and improve the quality of life.