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. 2020 Aug;12(8):4157-4167.
doi: 10.21037/jtd-19-2687.

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

Hyung Jun Park  1 , Sung Min Kim  2 , Hong Rae Kim  3 , Wonjun Ji  1 , Chang-Min Choi  1
Affiliations

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

Hyung Jun Park et al. J Thorac Dis. 2020 Aug.

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 (FEV1) was also an independent risk factor for postoperative infection [OR 95% CI: 1.61-2.26 (FEV1 50-80%); 2.27-4.21 (FEV1 <50%)]. Airflow limitation assessed by FEV1 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.

Keywords: Spirometry; chronic obstructive pulmonary disease (COPD); forced vital capacity (FVC); postoperative complications; thoracic surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-19-2687). CMC serves as an unpaid editorial board member of Journal of Thoracic Disease from Oct 2019 to Sep 2021. The other authors have no conflicts of interest to declare.

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