Preoperative Prediction of Pulmonary Complications Following Thoracic Surgery

Dales, Robert; G, Dionne; Leech, Judith A.; Lunau, Mary; Schweitzer, Irwin

doi:10.1378/chest.104.1.155

Cited by 144 publications

(64 citation statements)

References 22 publications

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“…These conditions could account for some of the discrepancy between the present study and other papers. Other studies support the present results [16,[21][22][23][24][25][26].…”

Section: Discussionsupporting

confidence: 91%

“…There has been debate about the clinical significance of exercise testing in preoperative evaluation, and there are conflicting results from the literature concerning the applicability of a symptom-limited exercise test. Some papers advocate the exercise test as a good predictor of postoperative complications [16,19,[21][22][23][24][25][26] and others do not [12,[27][28][29]. The studies differ in design, number of participating patients, registration of complications and statistical methods.…”

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confidence: 99%

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Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Larsen¹,

Ug²,

Milman³

et al. 1997

Eur Respir J

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The aim of this study was to evaluate which parameters of preoperative spirometry and cardiopulmonary exercise test are the best predictors of postoperative morbidity and mortality in patients with bronchogenic carcinoma.Ninety seven patients were prospectively and consecutively examined. All patients had preoperative maximal exercise test and dynamic spirometry. Postoperative complications and causes of death were registered. Logistic regression was used and models explaining the relationship between preoperative variables and postoperative complications and deaths were constructed.We found significant differences in preoperative maximal workload and carbon dioxide output between groups, with and without cardiopulmonary-related complications, but not in spirometry variables. Logistic regression showed maximal workload to be the only predictor of cardiopulmonary complications. Maximal oxygen uptake was predictive of cardiopulmonary deaths. Maximal oxygen uptake and forced expiratory volume were predictive of postoperative complications. A maximal oxygen uptake <50% predicted was associated with high risk of death from cardiopulmonary causes. Kaplan-Meier survival curves showed that maximal oxygen uptake was correlated to long-term survival, while spirometric variables were not.Exercise testing can be used in the preoperative evaluation of patients with nonmetastatic bronchogenic carcinoma. A combination of the results of variables from spirometry and exercise testing is proposed to be used as a preoperative criterion for operability. Eur Respir J 1997; 10: 1559-1565 Carcinoma of the lung is one of the most common causes of death due to cancer in men, and is increasingly common in women. Some 900,000 new cases are reported worldwide every year [1]. The prognosis in untreated cases is poor, and at present the major curative treatment modality for non-small cell carcinoma is resection. The removal of lung parenchyma from patients, who are usually smokers with compromised cardiovascular or pulmonary status, may lead to cardiopulmonary failure or death. Many variables have been used to assess the risk of postoperative complications, but it is not clear which of these parameters in preoperative pulmonary function testing are the best predictors of the operative outcome. Many centres recommend operation without additional testing in patients with a forced expiratory volume in one second (FEV1) >2.0 L or 60% of predicted and a diffusing capacity >60% pred [2][3][4][5][6]. If these requirements are not met, a perfusion or ventilation scan is performed, and the predicted postoperative FEV1 (FEV1,ppo) is estimated. The accuracy of these methods is proven [7][8][9][10][11] and it seems generally accepted that a FEV1,ppo of 0.8-1.0 L or 30% pred represents the lower limits of acceptable risk [4][5][6][12][13][14][15][16][17]. Some recommend different limits for different resections [18]. In spite of this consensus for identifying patients at risk, about 30% develop cardiopulmonary complications with a 30 day mortal...

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“…These conditions could account for some of the discrepancy between the present study and other papers. Other studies support the present results [16,[21][22][23][24][25][26].…”

Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Larsen¹,

Ug²,

Milman³

et al. 1997

Eur Respir J

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“…Testes aeróbicos de estresse, como subir escadas, podem ser mais efetivos para estratificação do risco do que a abordagem de cada órgão específico, pois traduzem a reserva do sistema cardiopulmonar 33 . Existe forte correlação entre pneumopatia e complicação pulmonar pós-operatória quando a doença pulmonar é avançada e está associada a VEF 1.0 menor que 35% da prevista 34 , a idade do paciente é superior a 75 anos 35 , ou o local do procedimento cirúrgico é o tórax 36 . O sexo masculino também está incluído como fator de risco.…”

Section: Mortalidade E Morbidade Pulmonar Pós-operatóriaunclassified

“…Aerobic stress tests, such as climbing stairs, may be more effective to stratify risk than addressing each specific organ, because they translate cardiopulmonary reserve 33 . There is a strong correlation between pneumopathies and postoperative pulmonary complications with advanced pulmonary disease associated to VEF 1.0 lower than 35% 34 , patients above 75 years of age 35 or surgical chest procedure 36 . The male gender is also included as a risk factor.…”

Section: Preoperative Pulmonary Function Evaluationmentioning

confidence: 99%

O sistema respiratório e o idoso: implicações anestésicas

Fernandes¹,

Neto²

2002

Rev. Bras. Anestesiol.

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RESUMO Fernandes CR, Ruiz Neto PP -O Sistema Respiratório e o Idoso: Implicações Anestésicas Justificativa e Objetivos -As complicações respiratórias são responsáveis por grande parte dos óbitos após procedimentos c i r ú r g i c o s q u e o c o r r e m n a p o p u l a ç ã o g e r i á t r i c Conteúdo -São apresentadas as alterações respiratórias fisiológicas do envelhecimento. São enfatizadas as alterações de volume e capacidades pulmonares, da mecânica respiratória e de trocas gasosas proporcionadas pela a n e s t e s i a . S ã o a b o r d a d o s a s p e c t o s r e l a t i v o s à morbimortalidade pulmonar pós-operatória em geriatria

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“…During treatment by chemotherapy, patients who stopped using tobacco were prepared for thoracic surgery. By analogy, two studies [6,9] demonstrated that preoperative preparation with physiotherapy and medication reduces risks of postoperative complications.…”

Section: Commentmentioning

confidence: 99%

Identification of prognostic factors determining risk groups for lung resection

Bernard¹,

Ferrand²,

Hagry³

et al. 2000

The Annals of Thoracic Surgery

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Background. Pulmonary resection belongs to a group of surgical procedures with significant morbidity and mortality. The aims of this study were to classify postoperative complications and to identify prognostic factors determining risk group.Methods. In a prospective study 500 patients undergoing lung resection (wedge resection, n ‫؍‬ 141; lobectomies, n ‫؍‬ 245; bilobectomies, n ‫؍‬ 12; and pneumonectomies, n ‫؍‬ 102) were included. In 178 patients (36%) pulmonary resections were extended to structures or thoracic organs. Sleeve resection of the bronchus to preserve lung parenchyma was performed in 22 patients.Results. Classification of postoperative complications fell into four categories: patients without postoperative complications; patients with moderate complications (n ‫؍‬ 137); patients with severe complications (n ‫؍‬ 38); and death (n ‫؍‬ 33). Factors adversely affecting postoperative complications by multivariate analysis included pulmonary pathology, bronchoplastic technique, forced expiratory volume in 1 second (FEV 1 ), extended resection, type of lung resection, comorbidity indices, and preoperative chemotherapy. Four risk groups were determined. Risk group I (n ‫؍‬ 60) with the best prognosis included patients with FEV 1 greater than or equal to 80%

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Preoperative Prediction of Pulmonary Complications Following Thoracic Surgery

Cited by 144 publications

References 22 publications

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

O sistema respiratório e o idoso: implicações anestésicas

Identification of prognostic factors determining risk groups for lung resection

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