The value of preoperative spirometry testing for predicting postoperative risk in upper abdominal and thoracic surgery assessed using big-data analysis

Abstract

Background:Spirometry is used to evaluate postoperative outcomes in thoracic surgery. However, the clinical utility of spirometry for predicting postoperative complications has not been determined. We used big-data analysis to examine the relationship between pulmonary function tests and postoperative complications. Methods:We retrospectively analysed clinical data from 31,827 patients who underwent spirometry within the 3 months prior to their surgery between January 2000 and December 2014 at a single tertiary referral hospital. The data were extracted in de-identified form via the automated clinical research information system. Surgical procedures included thoracic and upper abdominal surgery. Results:Multivariable logistic regression analysis showed that type of surgery, older age (>65 years), low albumin and smoking were associated with postoperative infections [95% confidence interval (CI) of the odds ratio (OR) 1.27-1.60 (>65 years); 1.52-1.96 (low albumin); 1.40-1.98 (current smoker)]. Notably, lower forced vital capacity (FVC) was an independent risk factor for postoperative infection, prolonged intensive care unit stay, and in-hospital death, regardless of airflow limitation [OR 95% CI: 1.31-1.69 (FVC 50-80%); 2.02-4.24 (FVC <50%)]. Lower forced expiratory volume in 1 sec (FEV 1 ) was also an independent risk factor for postoperative infection [OR 95% CI: 1.61-2.26 (FEV 1 50-80%); 2.27-4.21 (FEV 1 <50%)]. Airflow limitation assessed by FEV 1 was negatively correlated with postoperative infection in multivariable analysis (OR 95% CI: 0.51-0.88). Conclusions:Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.

Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up

“…Meanwhile, chronic M. tuberculosis infection has been shown to be an important correlate of poor patient nutritional status and reduced body mass index ( 32 ). In fact, nutritional status in turn has been shown to influence TB disease course and prognosis ( 33 ), which mechanistically may be due to reduced cellular immune function ( 34 ) and hypoalbuminemia in malnourished patients that increase risks of secondary postoperative infections ( 35 ) and respiratory failure ( 36 ). Therefore, improving preoperative nutritional status and correcting preoperative hypoalbuminemia may help to reduce the incidence of postoperative respiratory failure.…”

Update on preoperative evaluation and optimisation

“…Park JH et al . [ 33 ] in a critical review concluded that to predict postoperative infection and complications in thoracic and upper abdominal surgery, lower preoperative forced vital capacity values could be used regardless of airflow limitation.…”

“…So far, there is no evidence-based standard protocol for preoperative optimisation of the patient for surgery. [ 33 ] Depending upon the patient’s status, proposed surgery, and available resources, the preparation plan should be tailored for that particular patient. A multidisciplinary approach involving the patient, anaesthesiologist, surgeon, and specialist physician will be helpful.…”

Database study of risk factors for breast cancer-related lymphedema: statistical analysis of 2359 cases in 10 years

“…In recent years, database-based studies have become popular due to the increase in the size of studies and the number of items to be investigated. Database-based studies are also increasing in the investigation of risk factors for disease [25,26,27,28]. Studies using databases to study breast cancer include studies on treatment selection for breast cancer and epidemiological studies of male breast cancer [29,30], but no studies have used databases to identify risk factors for BCRL.…”