Original Articles
Assessment of pulmonary complications after lung resection

https://doi.org/10.1016/S0003-4975(99)00255-6Get rights and content

Abstract

Background. We assessed the utility of maximum oxygen consumption during exercise (MVO2) and diffusing capacity for carbon monoxide (DLCO) in the prediction of postoperative pulmonary complications, and the effect of such complications on postoperative length of hospital stay and the cost of hospitalization.

Methods. Candidates for lung resection were prospectively studied by preoperative measurement of DLCO (expressed as a percentage of predicted [DLCO%]) and MVO2. Postoperative pulmonary complications, duration of postoperative hospitalization, and the cost of hospitalization were assessed.

Results. Forty patients had lung resection with no operative mortality. The postoperative length of hospitalization was longer for the 13 patients who developed pulmonary complications compared with the 27 patients who did not (7.7 ± 0.8 vs 5.0 ± 0.4 days, respectively; p = 0.007), and the cost of hospitalization in the former group was higher ($11,530 ± $1,959 vs $6,578 ± $406, respectively; p = 0.031). Diffusing capacity was higher in patients without than in patients with pulmonary complications (DLCO% 90.1 ± 5.0 vs 65.3 ± 5.9; p = 0.0034). The mean MVO2 did not differ between the groups (17.8 ± 0.9 vs 16.3 ± 1.2). DLCO% predicted pulmonary complications (p = 0.006).

Conclusions. DLCO% predicts the likelihood of pulmonary complications after major lung resection, which are associated with increased length of hospital stay and cost.

Section snippets

Patients and methods

A prospective study was performed on patients operated on from May 1994 to August 1996. This protocol was approved by our institutional review board, and patients signed a separate informed consent form before entry into this study. Patients were eligible for entry if they had a predicted postoperative forced expiratory volume in 1 sec (FEV1) > 800 mL. This was calculated using the fraction of functional lung segments remaining after resection [7] or by radioisotope ventilation perfusion

Results

Forty patients who entered the study had a lung resection by open thoracotomy. There were 29 men and 11 women, with a mean age of 63.5 years (range 43 to 82 years). Thirty-five had non-small cell lung cancer, including 19 stage I, 3 stage II, 9 stage IIIA, 3 stage IIIB, and 1 stage IV, according to the American Joint Committee on Cancer staging system [17]. Five had pulmonary resection for other reasons. The operations performed were 29 lobectomies, 2 bilobectomies, and 9 segmental or wedge

Comment

Pulmonary complications in patients undergoing lung resection prolong hospital stay and cost, are associated with increased operative mortality, and predict long-term disability 9, 18. Hence, accurate prediction of which patients will develop pulmonary complications after lung resection may be helpful in determining in which patients the risk of surgery is acceptable. Spirometry has been used to predict the risk of complications after lung resection for more than four decades, and is still

References (27)

  • E Busch et al.

    Pulmonary complication in patients undergoing thoracotomy for lung carcinoma

    Chest

    (1994)
  • J Markos

    Pretreatment assessment of pulmonary functionrecent predictive studies using respiratory function tests

    Lung Cancer

    (1993)
  • T.P Smith et al.

    Exercise capacity as a predictor of post-thoracotomy morbidity

    Am Rev Resp Dis

    (1984)
  • Cited by (92)

    • Size-capacity mismatch in the lung: a novel predictor for complications after lung cancer surgery

      2017, Journal of Surgical Research
      Citation Excerpt :

      However, it has been reported that the cardiovascular complications that develop after VATS are more likely to result in a fatal outcome than the complications that occur after open surgery.3 Considering that postoperative cardiopulmonary complications tend to continue for the full length of the patient's stay and require expensive medical resources,4 the accurate prediction of cardiopulmonary complications after VATS is mandatory in the counseling of patients who will undergo VATS for lung cancer. With respect to the preoperative functional measures, forced expiratory volume in 1 s (FEV1) is considered to be the most valuable parameter in screening for patients who are at risk of postoperative cardiopulmonary complications.5

    View all citing articles on Scopus
    View full text