Preoperative fractional exhaled nitric oxide can predict postoperative cough-related quality of life and its recovery for early-stage non-small cell lung cancer patients: a longitudinal study

Abstract

Background Cough is a common respiratory symptom that affects quality of life (QOL) after video-assisted thoracic surgery (VATS). Our aim is to determine whether preoperative fractional exhaled nitric oxide (FENO) levels are able to predict the risk of postoperative cough and its changes and recovery using the Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC). Methods 292 patients with early-stage non-small cell lung cancer (NSCLC) were enrolled. 138 patients (47.2%) developed cough after VATS, 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 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 [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 in early-stage NSCLC patients.