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The Annals of Thoracic Surgery, Vol 44, 344-349, Copyright © 1987 by The Society of Thoracic Surgeons
D Bechard and L Wetstein
Determination of preoperative pulmonary function is crucial in avoiding
complications from pulmonary resection. Many have employed static pulmonary
function testing in an attempt to decrease morbidity and mortality from
lung resections. The purpose of the present study was to correlate
preoperative static pulmonary function, one-second forced expiratory volume
(FEV1), and exercise O2 consumption (MVO2) with postoperative morbidity and
mortality. Fifty consecutive patients underwent preoperative FEV1 and MVO2
determinations. A criterion for surgical resection included an FEV1 greater
than 1.7 liters for pneumonectomy, greater than 1.2 liters for lobectomy,
and greater than 0.9 liters for wedge resection. The surgeon was blinded as
to the results of MVO2 studies. Mean age was 63.8 years (range, 47 to 76
years). There were 10 pneumonectomies, 28 lobectomies, and 12 wedge
resections. Among the 50 surgical candidates selected solely on the
standard FEV1 values, mortality was 4% (2/50) and morbidity, 12% (6/50).
Stratification on the basis of exercise performance showed a 29% mortality
(2/7) and a 43% morbidity (3/7) in patients with an MVO2 less than 10
ml/kg/min. Patients with an MVO2 less than 20 but greater than 10 ml/kg/min
had a 10.7% morbidity (3/28), and there were no deaths. No patients with an
MVO2 greater than 20 ml/kg/min sustained any morbidity or died (p less than
0.001). We conclude that exercise is an important criterion in the
preoperative evaluation of patients for pulmonary surgery. An MVO2 less
than 10 ml/kg/min is associated with significant morbidity and mortality.
ARTICLES
Assessment of exercise oxygen consumption as preoperative criterion for lung resection
Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0001.
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