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Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
Accepted for publication April 3, 2009.
* Address correspondence to Dr Cerfolio, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294 (Email: robert.cerfolio{at}ccc.uab.edu).
Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.
Background: The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) is an important pulmonary function test (PFT) obtained before elective pulmonary resection. However, there are several DLCO values reported and it is unknown which ones are important predictors of postoperative morbidity.
Methods: This is a retrospective study of a prospective database of patients who underwent PFTs and pulmonary resection by one surgeon. The PFTs evaluated were as follows: forced expiratory volume in one second (FEV1%), minute ventilation volume (MVV%), and three types of diffusion capacity of the lung for carbon monoxide values: the diffusion capacity of the lung for carbon monoxide (DLCO%), the DLCO adjusted for hemoglobin (DL adjusted%), and the DLCO adjusted for alveolar volume (DLCO/VA%).
Results: There were 906 patients between January 2005 and December 2007, and lobectomy was performed most commonly. Complications occurred in 254 patients (28%) and were respiratory in 115 (13%). On univariate analysis, age (p < 0.001), number of cigarettes smoked (p = 0.008), history of coronary artery disease (p = 0.028), FEV1% (p = 0.021), postoperative predicted (ppo) FEV1% (p < 0.001), DLCO% (p = 0.018), ppoDLCO% (p = 0.002), and DLCO/VA% (p = 0.004) were significantly different among those who did and did not experience postoperative respiratory morbidity. Multivariate regression analysis identified ppoDLCO%, ppoFEV1%, DLCO/VA%, and age as significant independent predictors of respiratory morbidity. Operative mortality was 2% (18 patients).
Conclusions: Although age, FEV1%, ppoFEV1%, DLCO%, and ppoDLCO% are all well-known predictors of operative morbidity after elective pulmonary resection, the DLCO/VA% is another important predictor. This information should be included to help guide patient selection for pulmonary resection and to determine preoperative risk stratification.
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S. i. Takeda Changes in Pulmonary Function Tests After Neoadjuvant Therapy Predict Postoperative Complications: DLCO/VA% is More Important Than Predicted Postoperative %DLCO? Ann. Thorac. Surg., May 1, 2010; 89(5): 1706 - 1707. [Full Text] [PDF]
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R. J. Cerfolio, A. Talati, and A. S. Bryant Changes in Pulmonary Function Tests After Neoadjuvant Therapy Predict Postoperative Complications Ann. Thorac. Surg., September 1, 2009; 88(3): 930 - 936. [Abstract] [Full Text] [PDF]
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