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Ann Thorac Surg 2007;83:1134-1139
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Predicted Versus Observed FEV₁ and DLCO After Major Lung Resection: A Prospective Evaluation at Different Postoperative Periods

Division of Thoracic Surgery, "Umberto I" Regional Hospital, Ancona, Italy

Accepted for publication November 20, 2006.

^_* Address correspondence to Dr Brunelli, Via S. Margherita 23, Ancona 60129, Italy (Email: alexit_2000{at}yahoo.com).

Background: The objective of this study was to prospectively assess the agreement between predicted and observed postoperative values of forced expiratory volume in 1 second (FEV₁) and carbon monoxide lung diffusion capacity (DLCO) after major lung resection.

Methods: Two hundred consecutive patients undergoing lobectomy or pneumonectomy for lung cancer in a single center were prospectively evaluated with complete preoperative and repeated postoperative measurements of FEV₁ and DLCO. Predicted postoperative (ppo) values were compared with the observed postoperative values. The precision of ppoFEV₁ and ppoDLCO at 3 months was subsequently evaluated by plotting the cumulative predicted postoperative values against the observed ones.

Results: After lobectomy, observed values were 11% lower at discharge (p < 0.0001), and 6% higher at 3 months (p < 0.0001), compared with ppoFEV₁. No differences were noted at 1 month. Observed DLCO values were 12% lower than predicted at discharge (p < 0.0001) and 10% higher than predicted at 3 months (p < 0.0001), without differences noted at 1 month. After pneumonectomy, no differences were noted between predicted and observed values of FEV₁ at every evaluation time, and of DLCO at discharge and 1 month. However, the observed DLCO value was 17% higher than predicted at 3 months (p = 0.002). Plots of predicted and observed postoperative values at 3 months showed that ppoFEV₁ predicted worse at lower levels of ppoFEV₁, and ppoDLCO was constantly lower than the observed values at every ppoDLCO levels.

Conclusions: Given the imprecision of the prediction of postoperative function, particularly of gas exchange determinants and after pneumonectomy, and at low ppoFEV₁ levels, the use of ppoFEV₁ and ppoDLCO for risk stratification needs to be reconsidered.

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