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Optimizing selection of patients for major lung resection
M K Ferguson1, L B Reeder, R Mick
1Department of Surgery, University of Chicago, IL 60637.
The Journal of Thoracic and Cardiovascular Surgery
|February 1, 1995
Summary
Predicted postoperative diffusing capacity is the strongest predictor of complications and mortality after lung resection. Spirometry and diffusing capacity should be assessed independently for accurate operative risk estimation.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Cardiopulmonary Physiology
Background:
- Assessing operative risk for lung resection is crucial, especially for patients with borderline lung function.
- The interplay between diffusing capacity for carbon monoxide (DLCO) and spirometry in predicting outcomes remains unclear.
Purpose of the Study:
- To identify the most significant predictors of morbidity and mortality following major lung resection.
- To investigate potential interactions between DLCO and spirometry in estimating postoperative risks.
Main Methods:
- Retrospective analysis of 376 patients undergoing lung resection (lobectomy, bilobectomy, or pneumonectomy).
- Evaluation of 23 preoperative variables against 18 postoperative events, including pulmonary/cardiac complications, overall morbidity, and mortality.
- Multivariate logistic regression was used to identify independent predictors.
Main Results:
- Percent predicted postoperative diffusing capacity (pp-DLCO) was the strongest single predictor of complications and mortality.
- Pulmonary complications, morbidity, and mortality were inversely related to pp-DLCO (p < 0.004).
- pp-DLCO and age were independent predictors of pulmonary complications, morbidity, and death; prior myocardial infarction predicted cardiac complications.
Conclusions:
- pp-DLCO is the paramount predictor for risk assessment in lung resection surgery.
- pp-DLCO and percent predicted postoperative forced expiratory volume in 1 second (pp-FEV1) have minimal interrelationship.
- These pulmonary function tests should be evaluated independently to accurately estimate operative risk.