Preoperative fractional exhaled nitric oxide is a risk and predictive factor of postoperative cough for early-stage non-small cell lung cancer patients: a longitudinal study

Abstract

Background: To determine whether preoperative fractional exhaled nitric oxide (FENO) levels is a risk and predictive factor of postoperative cough and its changes and recovery using the Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC). Methods: 292 early-stage non-small cell lung cancer (NSCLC) patients without preoperative cough were enrolled. 138 patients (47.2%) developed postoperative cough, univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of postoperative cough. For an exploratory analysis, patients with cough were divided into low and high- FENO [≥31 parts per billion (ppb)] groups. The LCQ-CM was used to evaluate changes in postoperative cough and recovery trajectory over time between the two groups for 12 months after surgery. Results: The independent factors of postoperative cough included preoperative FENO levels [odds ratio (OR) 1.106, 95% confidence interval (CI): 1.076–1.137, p < 0.001] and duration of anesthesia (OR 1.008, 95% CI: 1.002–1.013, p = 0.004). The low-FENO group reported significantly higher LCQ-MC scores at 1 month after surgery and returned to preoperative physical (28 vs. 91 days), psychological (28 vs. 60 days), social (28 vs. 80 days) and total (28 vs. 91 days) scores faster than the high-FENO group (all p < 0.05). Conclusion: Higher preoperative FENO level and longer duration of anesthesia were independent risk factors related to postoperative cough. Additionally, patients with lower preoperative FENO levels had better cough-related quality of life and faster recovery from postoperative cough.