Lung resection and new postoperative home oxygen requirement: a systematic review

While patients are assessed for their ability to tolerate surgery through physiologic evaluations such as pulmonary function tests, ventilation-perfusion scans, and exercising testing, some patients still require home oxygen therapy after pulmonary resection. It is not well understood what the associated risk factors are, how long patients need supplemental oxygen, and if this requirement is associated with worse long-term outcomes. Given these knowledge gaps, we sought to conduct a systematic review of pulmonary resections and new postoperative home oxygen requirement.

A comprehensive search of PubMed was conducted from inception to August 2023 for studies reporting new home oxygen requirement in adults after pulmonary resection. If all participants were already on home oxygen, if no patients required home oxygen after surgery, or full text was not available in English the study was excluded. Odds ratios from available studies were statistically combined using a meta-analytic approach into a forest plot, allowing for a more precise estimate of the effect size than any single study.

A total of 17 studies capturing 26,093 patients, 3,796 of whom were discharged on home oxygen, were included in the review. The majority of studies focused on patients undergoing resection for malignant etiologies. Female sex, White race, obesity, and non-adenocarcinoma histology were most commonly found to be associated with increased risk for home oxygen. Tobacco use and pulmonary function studies [e.g., forced expiratory volume in one second (FEV₁) and diffusing capacity of the lungs for carbon monoxide (DLCO)] lost significance on multivariable analysis. While few of the studies captured duration and outcomes associated with home oxygen, the ones that did found that nearly 50% of patients were still on home oxygen after 6 months and that the need for home oxygen even during the first month was associated with increased risk for mortality.

Requiring home oxygen after surgery may be associated with worse outcomes. Additional studies on the factors associated with requiring postoperative home oxygen are needed. This would allow for more accurate preoperative counseling as well as target modifiable risk factors for optimization.