Pulmonary function tests for the prediction of postoperative pulmonary complications—a systematic review

Dankert, André; Dohrmann, Thorsten; Löser, Benjamin; Zapf, Antonia; Zöllner, Christian; Petzoldt, Martin

doi:10.3238/arztebl.m2022.0074

Cited by 7 publications

(16 citation statements)

References 73 publications

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“…Although TVE images and videos were not routinely available for the anesthetists in the study period, the retrospective nature of this study is a well-recognized limitation and a potential source for selection and diagnostic review bias. 40 …”

Section: Discussionmentioning

confidence: 99%

Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model

Barclay-Steuart

Großhennig

Sasu

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Transnasal flexible videoendoscopy (TVE) of the larynx is a standard of care for the detection and staging of pharyngolaryngeal lesions in otorhinolaryngology. Patients frequently present with existing TVE examinations before anesthesia. Although these patients are considered high risk, the diagnostic value of TVE for airway risk stratification is currently unknown. How can captured images or videos be used for anesthesia planning, and which lesions are most concerning? This study aimed to develop and validate a multivariable risk prediction model for difficult airway management based on TVE findings and to determine whether the discrimination of the Mallampati score can be improved by adding this new TVE model. METHODS: This retrospective single-center development and validation study assessed 4021 patients who underwent 4524 otorhinolaryngologic surgeries at the University Medical Centre Hamburg-Eppendorf between January 1, 2011, and April 30, 2018, with electronically stored TVE videos and included 1099 patients who underwent 1231 surgeries. TVE videos and anesthesia charts were systematically reviewed in a blinded fashion. The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used for variable selection, model development, and cross validation. RESULTS: The prevalence of difficult airway management was 24.7% (304/1231). Lesions at the vocal cords, epiglottis, or hypopharynx were not selected by the LASSO regression, while lesions at the vestibular folds (ß-coefficient 0.123), supraglottic region (ß-coefficient 0.161), arytenoids (ß-coefficient 0.063), and viewing restrictions on the rima glottidis that cover ≥50% of the glottis area (ß-coefficient 0.485) and pharyngeal secretion retention (ß-coefficient 0.372) were relevant risk factors for difficult airway management. The model was adjusted for sex, age, and body mass index. The area under the receiver operating characteristic curve (95% confidence interval) of the Mallampati score was 0.61 (0.57–0.65) and 0.74 (0.71–0.78) of the TVE model combined with Mallampati ( P < .001). CONCLUSIONS: Stored images and videos from TVE examinations can be reused for the purpose of predicting risk associated with airway management. Vestibular fold, supraglottic, and arytenoid lesions are most concerning, especially if they are accompanied by secretion retention or restrict the glottic view. Our data indicate that the TVE model improves discrimination of the Mallampati score and might, therefore, be a useful addition to traditional bedside airway risk examinations.

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Section: Discussionmentioning

confidence: 99%

Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model

Barclay-Steuart

Großhennig

Sasu

et al. 2023

Anesthesia &Amp; Analgesia

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“… 37 The value of spirometry in predicting PPCs after lung resection has been demonstrated by several retrospective studies. 19 38–40 However, the association between spirometry and perioperative respiratory complications in adults with mediastinal mass remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…FEV 1 , which predicts the degree of respiratory impairment in patients with COPD, is a critical tool to evaluate a patient for thoracic surgery with preoperative FEV 1 less than 60% predicted strongly indicating PPCs and 30-day mortality 37. The value of spirometry in predicting PPCs after lung resection has been demonstrated by several retrospective studies 19 38–40. However, the association between spirometry and perioperative respiratory complications in adults with mediastinal mass remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate assessment of pulmonary function has been claimed to improve risk assessment of pulmonary complications 15 16. Accordingly, preoperative pulmonary function tests (PFTs) are recommended in patients scheduled for lung resection,17 cardiac18 or non-thoracic surgery,19 where spirometry, a specialised non-invasive test to measure lung function, may contribute to identifying patients at high risk of PPCs 20. Especially, the prognostic value of forced expiratory volume in 1 s (FEV 1 ) and the ratio of FEV 1 to forced vital capacity (FVC) have been rationally well established in aortocoronary bypass surgery and lung resection, with a reduced FEV 1 and FEV 1 /FVC strongly associated with postoperative mortality and complications 21 22.…”

Section: Introductionmentioning

confidence: 99%

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Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study

Zhang

et al. 2023

BMJ Open

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IntroductionPatients with a mediastinal mass are at risk of pulmonary complications in the perioperative period. Preoperative spirometry tests are recommended in patients scheduled for thoracic surgery. Our objective is to investigate the association between preoperative spirometry results and the incidence of postoperative pulmonary complications in patients following mediastinal mass resection, which may determine the usefulness of spirometry tests in the prediction of the perioperative respiratory risk.Methods and analysisThis protocol describes a retrospective cohort study of patients with mediastinal masses in Shanghai Pulmonary Hospital between 1 September 2021 and 1 September 2022, with a planned sample size of 660 patients. The primary aim of this study is to explore the association between preoperative spirometry results and the occurrence of postoperative pulmonary complications after mediastinal mass resection. Logistic regression analysis will be used to calculate the adjusted incidence rate difference and incidence rate ratios (with 95% CIs).Ethics and disseminationThe study was approved by the ethics committee of Shanghai Pulmonary Hospital (K21-372Y). The results of the study will be submitted to a peer-reviewed biomedical journal for publication and presented at relevant conferences.

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“…7,8 Pulmonary function tests (PFTs), such as spirometry and blood gas analysis, have been claimed to improve preoperative pulmonary risk assessment, but the scientific literature is conflicting. 9–17…”

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confidence: 99%

Preoperative Spirometry in Patients With Known or Suspected Chronic Obstructive Pulmonary Disease Undergoing Major Surgery: The Prospective Observational PREDICT Study

Dankert

Neumann-Schirmbeck

Dohrmann

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Pulmonary function tests (PFTs) such as spirometry and blood gas analysis have been claimed to improve preoperative pulmonary risk assessment, but the scientific literature is conflicting. The Preoperative Diagnostic Tests for Pulmonary Risk Assessment in Chronic Obstructive Pulmonary Disease (PREDICT) study aimed to determine whether preoperative PFTs improve the prediction of postoperative pulmonary complications (PPCs) in patients with known or suspected chronic obstructive pulmonary disease (COPD) undergoing major surgery. A secondary aim was to determine whether the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) classification of airflow limitation severity (grades I–IV) is associated with PPC. METHODS: In this prospective, single-center study, patients with GOLD key indicators for COPD scheduled for major surgery received PFTs. Patients with confirmed COPD (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≤0.7) were included in the COPD cohort and compared with a reference cohort without COPD. We developed 3 multivariable risk prediction models and compared their ability to predict PPC: the “standard model” (medical preconditions, and sociodemographic and surgical data), the “COPD assessment model” (additional GOLD key indicators, pack-years, and poor exercise capacity), and the “PFT model” (additional PFT parameters selected by adaptive least absolute shrinkage and selection operator [LASSO] regression). Multiple LASSO regressions were used for cross-validation. RESULTS: A total of 31,714 patients were assessed for eligibility; 1271 individuals received PFTs. Three hundred twenty patients (240 with confirmed COPD: 78 GOLD I, 125 GOLD II, 28 GOLD III, 9 GOLD IV, and 80 without COPD) completed follow-up. The diagnostic performance was similar among the standard model (cross-validated area under the curve [cvAUC], 0.723; bias-corrected bootstrapped [bc-b] 95% confidence interval [CI], 0.663–0.775), COPD assessment model (cvAUC, 0.724; bc-b 95% CI, 0.662–0.777), and PFT model (cvAUC, 0.729; bc-b 95% CI, 0.668–0.782). Previously known COPD was an independent predictor in the standard and COPD assessment model. %FEV1PRED was the only PFT parameter selected by LASSO regression and was an independent predictor in the PFT model (adjusted odds ratios [OR], 0.98; 95% CI, 0.967–.0.998; P = .030). The risk for PPC significantly increased with GOLD grades (P < .001). COPD was newly diagnosed in 53.8% of the patients with confirmed COPD; however, these individuals were not at increased risk for PPC (P = .338). CONCLUSIONS: COPD is underdiagnosed in surgical patients. Patients with newly diagnosed COPD commonly presented with low GOLD severity grades and were not at higher risk for PPC. Neither a structured COPD-specific assessment nor preoperative PFTs added incremental diagnostic value to the standard clinical preassessment in patients with known or suspected COPD. Unnecessary postponement of surgery and undue health care costs can be avoided.

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Pulmonary function tests for the prediction of postoperative pulmonary complications—a systematic review

Cited by 7 publications

References 73 publications

Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model

Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model

Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study

Preoperative Spirometry in Patients With Known or Suspected Chronic Obstructive Pulmonary Disease Undergoing Major Surgery: The Prospective Observational PREDICT Study

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