Updated Analysis of the Impact of Pulmonary Function Tests on Complications After Lung Resection

Most data regarding the prognostic value of pulmonary function tests are >10 years old. With increased adoption of minimally invasive surgery and sublobar resection, updated outcomes data are important for counseling higher risk patients considering lung resection.

We conducted a retrospective analysis of patients undergoing elective lung resection from 2013-2023. A composite outcome of respiratory complications was defined. Forced expiratory volume in 1 second (FEV₁) and diffusing capacity of lung for carbon monoxide (Dlco) were stratified into 20% intervals, and postoperative outcomes were analyzed. Multivariable models incorporating FEV₁, Dlco, and relevant patient and operative factors assessed the impact of these variables on respiratory complications, length of stay, and mortality.

Of the 1532 patients undergoing pulmonary resection, postoperative respiratory complications occurred in 8.6%, median length of stay was 4 days, and 30-day mortality was 1.1%. Analysis of FEV₁ and Dlco intervals showed increased respiratory complications with decreased FEV₁ and Dlco, but in multivariable analysis only FEV₁ was a significant predictor of complications (P < .001), not Dlco. Higher FEV₁ was associated with shorter length of stay, while Dlco was not significant. Mortality was associated with lower FEV₁. Minimally invasive surgery mitigated the effects of lower FEV₁ on complications.

In our study, FEV₁ remains a risk factor for postoperative morbidity and mortality, while Dlco is not. Minimally invasive approaches mitigate complications among patients with worse pulmonary function. These findings can assist in counseling patients with marginal pulmonary function considering lung resection.