Cardiopulmonary Testing Before Lung Resection: What Are Thoracic Surgeons Doing?

Clark, James M.; Marrufo, Angelica S.; Kozower, Benjamin D.; Tancredi, Daniel J.; Nuño, Miriam A; Cooke, David T.; Pollock, Bradley H; Romano, Patrick S.; Brown, Lisa M.

doi:10.1016/j.athoracsur.2019.04.057

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…With conflicting recommendations from available guidelines, it is reasonable to assume this will lead to variation in lung cancer surgical care. Recent studies have reported important quality gaps in treatment delivery (17) and unwarranted care variation (18), leading to significant variation in preoperative cardiopulmonary assessment practices (19) and surgical resection rates (20). Whether there are also differences in preoperative diagnostic testing, leading to variation in proportion of patients being operated without a preoperative pathological diagnosis, remains to be clarified.…”

Section: Introductionmentioning

confidence: 99%

Surgery without preoperative histological confirmation of lung cancer: what is the current clinical practice?

Ghamati¹,

Li²,

Heijden³

et al. 2021

J Thorac Dis

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Background: There are discordances in the guidelines regarding the need to acquire histological diagnosis before surgical treatment of (presumed) lung cancer. Preoperative histological confirmation is always encouraged in this setting to prevent unnecessary surgery or when sublobar resection for small-sized tumors is considered. The aim of this retrospective cohort study was to assess the proportion of patients undergoing lung cancer resection in the Netherlands without preoperative pathological confirmation, based on the intraoperative pathological diagnosis (IOD) rate, and to determine characteristics that may influence IOD frequency. Methods: Data on 10,226 patients, who underwent surgical treatment for lung cancer from 2010 to 2015, were retrieved from the Netherlands National Cancer Registry. We registered an IOD when the date of diagnosis equaled the date of the first surgical intervention. Tabulations and multivariable logistic regression were used to identify predictive parameters for IOD. Results: 36% of surgical procedures were classified as IOD, and decreased with increasing tumor size and extent of surgery (57% for segmentectomy, 39% for lobectomy and 11% for pneumonectomy). IOD was more frequently observed in adenocarcinoma (41%), varied between hospitals from 13% to 66% and was less common when patients were referred from a hospital where thoracic surgery was not performed. Previous history of cancer did not affect IOD. Conclusions: More than one-third of patients with suspected lung cancer in the Netherlands was operated without preoperative histological confirmation. There was significant variation in IOD rates between different hospitals, which deserves further detailed analysis when striving for uniform surgical quality of care for patients with lung cancer.

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Section: Introductionmentioning

confidence: 99%

Surgery without preoperative histological confirmation of lung cancer: what is the current clinical practice?

Ghamati¹,

Li²,

Heijden³

et al. 2021

J Thorac Dis

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“…However, it is also the most difficult to carry out in everyday practice, as none of the thoracic surgeons interviewed in a recent American survey prescribe a SWT. 23 Comparatively to the SWT and SCT, the 3CRT can be performed in nearly any care setting, including very limited spaces such as consultation rooms by surgeons themselves, or allied health professionals, and could be sufficient to determine the need for presurgical CPX in patients with NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the 3‐minute chair rise test as part of preoperative evaluation for patients with non‐small cell lung cancer

et al. 2020

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Background Peak oxygen uptake (trueV˙O2peak) measured by a cardiopulmonary exercise test (CPX) is the gold‐standard for predicting surgical risk in patients with non‐small cell lung cancer (NSCLC). The 3‐minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict trueV˙O2peak in patients with NSCLC. Methods Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive trueV˙O2peak equation based on performance on the 3CRT. In addition, sensitivity‐specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of trueV˙O2peak ≥ 15 mL/kg/minute. Results The following equation was obtained: trueV˙O2peak predicted = (0.04765 × FEV1) ‐ (0.207 59 × BMI) ‐ (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r2 = 0.75, P < 0.01. The bias between the trueV˙O2peak values predicted and measured during CPX was 0.0 ± 1.7 mL/kg/minute (95% limits of agreement [−3.5 to 3.5]). A performance ≥49 chair rises predicted trueV˙O2peak ≥ 15 mL/kg/minute with a sensitivity of 0.75 and a specificity of 0.81. Conclusions The level of error in the prediction of trueV˙O2peak from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of trueV˙O2peak. Nevertheless, the 3CRT could help to identify those patients that require CPX prior to lung resection surgery for NSCLC, larger prospective study is needed to confirm this hypothesis. Key points Significant findings of the study Cardiopulmonary exercise tests can stratify the surgical risk. Prediction of the peak oxygen uptake (trueV˙O2peak) value from the 3CRT yields an unacceptable level of error. However, a performance of 49 chair rises or more during the 3CRT could indicate a trueV˙O2peak ≥ 15 mL / kg / minute. What this study adds The 3CRT is a useful screening tool to determine the necessity for a comprehensive cardiopulmonary exercise test, whose access is limited in clinical practice. It could also allow early screening of patients requiring specific prehabilitation programs.

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“…Preoperative smoking cessation is associated with a reduction in postoperative pulmonary complications, especially after thoracic surgery . A longer time of smoking cessation prior to an elective operation is associated with a lower risk of pulmonary complications . Therefore, the period between the initial outpatient visit with a surgeon and the surgery date is a critical time to encourage smoking cessation to reduce the risk of postoperative complications and increase the chance of long-term smoking cessation.…”

Section: Introductionmentioning

confidence: 99%

Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic

et al. 2020

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Smoking quitline programs effectively promote smoking cessation in outpatient primary care settings.OBJECTIVE To examine the factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted from January 1, 2014, to December 31, 2018, among 111 active smoking patients referred to the quitline from a thoracic surgery outpatient clinic visit. Patients were divided into operative and nonoperative cohorts. MAIN OUTCOMES AND MEASURESPrimary outcomes were engagement rates in the quitline program and successful smoking cessation. Secondary outcomes were self-reported point prevalence abstinence at 1 month and 6 months after the smoking quit date. RESULTSOf 111 patients (62 men; mean [SD] age, 61.8 [11.2] years) who had a quitline referral, 58 (52%) underwent surgery, and 32 of these 58 patients (55%) participated in the program. Of the 53 nonoperative patients (48%), 24 (45%) participated in the program. In the operative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (21 of 32 [66%] vs 16 of 6 [62%]; P = .79) or in point prevalence abstinence at 1 month (23 of 32 [72%] vs 14 of 25 [56%]; P = .27) or 6 months (14 of 28 [50%] vs 6 of 18 [33%]; P = .36). Similarly, in the nonoperative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (8 of 24 [33%] vs 11 of 29 [38%]; P = .78) or in point prevalence abstinence at 1 month (7 of 24 [29%] vs 8 of 27 [30%]; P = .99) or 6 months (6 of 23 [26%] vs 6 of 25 [24%]; P = .99). Regardless of quitline participation, operative patients had a 1.8-fold higher proportion of successful smoking cessation compared with nonoperative patients (37 of 58 [64%] vs 19 of 53 [36%]; P = .004) as well as a 2.2-fold higher proportion of 1-month point prevalence abstinence (37 of 57 [65%] vs 15 of 51 [29%]; P < .001) and a 1.8-fold higher proportion of 6-month point prevalence abstinence (20 of 45 [44%] vs 12 of 48 [25%]; P = .05). Having surgery doubled the odds of smoking cessation (odds ratio, 2.44; 95% CI, 1.06-5.64; P = .04) and quitline engagement tripled the odds of remaining smoke free at 6 months (odds ratio, 3.57; 95% CI, 1.03-12.38; P = .04). CONCLUSIONS AND RELEVANCEPatients undergoing thoracic surgery were nearly twice as likely to quit smoking as those who did not have an operation, and smoking quitline participation further augmented point prevalence abstinence. Improved smoking cessation rates, even among nonoperative patients, were associated with appropriate outpatient counseling and intervention.

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Cardiopulmonary Testing Before Lung Resection: What Are Thoracic Surgeons Doing?

Cited by 12 publications

References 24 publications

Surgery without preoperative histological confirmation of lung cancer: what is the current clinical practice?

Surgery without preoperative histological confirmation of lung cancer: what is the current clinical practice?

Evaluation of the 3‐minute chair rise test as part of preoperative evaluation for patients with non‐small cell lung cancer

Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic

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