Analysis of pulmonary complications and predicted postoperative pulmonary function in oncologic lung resections

Background: Postoperative pulmonary complications (PPCs) represent a significant source of morbidity and mortality in surgical patients. Measurement of predicted postoperative forced expiratory volume in the first second (ppo FEV1) may allow for reliable prediction of PPCs and perioperative planning. This study aimed to determine if impaired ppo FEV1 is associated with increased risk of PPCs following oncologic lung resection. Methods: Patients who underwent elective pulmonary resection at The Ottawa Hospital between 2008 and 2018 were evaluated. The presence and severity of PPCs as defined by the Ottawa Thoracic Morbidity & Mortality system were analyzed. The incidence of PPCs was evaluated based on different ppo FEV1 cut-off values (40%, 50%, and 60%), and a multivariable logistic regression was performed to identify predictors of PPCs. Results: Of 1,949 included patients, a thoracoscopic approach (64.4%) was most frequently utilized, and lobectomies represented the most common procedure (60.5%). All cut-off ppo FEV1 values of <40% (P<0.001), <50% (P<0.001), and <60% (P=0.004) were associated with more frequent PPCs (13.0%, 11.6%, and 7.6%, respectively), while only ppo FEV1 <50% showed differences in both minor (P<0.001) and major (P=0.005) PPCs. With ppo FEV1 <50%, differences in PPCs were demonstrated specifically in both thoracoscopic (P=0.03) and open (P=0.003) procedures. On multivariable analysis, ppo FEV1 <50% (P=0.03) and need for operative conversion (P<0.001) independently predicted PPCs. Conclusions: Routine assessment of ppo FEV1 is a practical strategy to identify patients at increased risk of developing PPCs, and can identify candidates for preoperative optimization and postoperative pulmonary support.