The risk of post-operative pulmonary complications in lung resection candidates with normal forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide: a prospective multicentre study

Introduction According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) are at low risk for post-operative pulmonary complications (PPC). However, PPC affect hospital length of stay and related healthcare costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV1 and DLCO (>80% predicted) and identify factors associated with PPC. Methods 398 patients were prospectively studied at two centres between 2017 and 2021. PPC were recorded from the first 30 post-operative days. Subgroups of patients with and without PPC were compared and factors with significant difference were analysed by uni- and multivariate logistic regression. Results 188 subjects had normal FEV1 and DLCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (PETCO2) at rest (27.7 versus 29.9; p=0.033) and higher ventilatory efficiency (V′E/V′CO2) slope (31.1 versus 28; p=0.016) compared to those without PPC. Multivariate models showed association between resting PETCO2 (OR 0.872; p=0.035) and V′E/V′CO2 slope (OR 1.116; p=0.03) and PPC. In both models, thoracotomy was strongly associated with PPC (OR 6.419; p=0.005 and OR 5.884; p=0.007, respectively). Peak oxygen consumption failed to predict PPC (p=0.917). Conclusions Resting PETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and DLCO. We propose resting PETCO2 be an additional parameter to FEV1 and DLCO for preoperative risk stratification. In addition to FEV1 and DLCO, resting PETCO2 and V′E/V′CO2 slope deliver additional information on risk of post-operative pulmonary complication development in lung resection candidates https://bit.ly/3Erv0DB

[1]  V. Šrámek,et al.  Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide. , 2022, The Annals of thoracic surgery.

[2]  A. Cuvelier,et al.  Prehabilitation sessions can be provided more frequently in a shortened regimen with similar or better efficacy in people with non-small cell lung cancer: a randomised trial. , 2021, Journal of physiotherapy.

[3]  I. Čundrle,et al.  Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy. , 2019, Interactive cardiovascular and thoracic surgery.

[4]  T. Nagayasu,et al.  Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection. , 2018, Lung cancer.

[5]  J. Moisés,et al.  Prehabilitation in thoracic surgery. , 2018, Journal of thoracic disease.

[6]  M. Stringer.  Acute appendicitis , 2017, Journal of paediatrics and child health.

[7]  Z. Tothova,et al.  Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures. , 2016, The Annals of thoracic surgery.

[8]  J. L. Valera,et al.  Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  V. Somers,et al.  Exercise end-tidal CO2 predicts central sleep apnea in patients with heart failure. , 2015, Chest.

[10]  O. Sadr-Azodi,et al.  Mortality after a cholecystectomy: a population-based study. , 2015, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[11]  P. Mazzone,et al.  Preoperative evaluation of the patient with lung cancer being considered for lung resection , 2015, Current opinion in anaesthesiology.

[12]  J. Dunning,et al.  Does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? , 2013, Interactive cardiovascular and thoracic surgery.

[13]  R. Hubbard,et al.  Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit , 2013, Thorax.

[14]  Bruce D. Johnson,et al.  Modulation of ventilatory reflex control by cardiac resynchronization therapy. , 2012, Journal of cardiac failure.

[15]  C. Pompili,et al.  Minute ventilation-to-carbon dioxide output (VE/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection. , 2012, The Annals of thoracic surgery.

[16]  Bruce D. Johnson,et al.  Causes of breathing inefficiency during exercise in heart failure. , 2010, Journal of cardiac failure.

[17]  B. Naidu,et al.  Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? , 2010, Thorax.

[18]  M. Bugiani,et al.  Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. , 2010, European Journal of Cardio-Thoracic Surgery.

[19]  L. Goldman,et al.  ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) , 2009, European Respiratory Journal.

[20]  D. Boffa,et al.  Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. , 2008, The Journal of thoracic and cardiovascular surgery.

[21]  J. Hankinson,et al.  General considerations for lung function testing , 2005, European Respiratory Journal.

[22]  A. Flahault,et al.  Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. , 2000, Chest.

[23]  R. Casaburi,et al.  Inaccuracy of noninvasive estimates of VD/VT in clinical exercise testing. , 1994, Chest.

[24]  D R Bassett,et al.  Limiting factors for maximum oxygen uptake and determinants of endurance performance. , 2000, Medicine and science in sports and exercise.