Value of preoperative spirometry test in predicting postoperative pulmonary complications in high-risk patients after laparoscopic abdominal surgery

Abstract

Whether preoperative spirometry in non-thoracic surgery can predict postoperative pulmonary complications (PPCs) is controversial. We investigated whether preoperative spirometry results can predict the occurrence of PPCs in patients who had undergone laparoscopic abdominal surgery. This retrospective observational study analyzed the records of patients who underwent inpatient laparoscopic gastric or colorectal cancer surgery at Seoul National University Bundang Hospital between January 2010 and June 2017. Preoperative spirometry was performed for patients at a high risk of PPCs, such as elderly patients (age >60 years), patients aged <60 years with chronic pulmonary disease, and current smokers. The main outcome was the association between the results of spirometry tests performed within 1 month prior to surgery and the occurrence of PPCs, as determined by multivariable logistic regression analysis. Of the 898 included patients who underwent laparoscopic gastric (372 patients) or colorectal cancer surgery (526 patients), PPC occurred in 117 patients (gastric cancer: 74, colorectal cancer: 43). A 1% greater preoperative forced vital capacity (FVC) was associated with a 2% lower incidence of PPCs after laparoscopic gastric or colorectal cancer surgery (odds ratio: 0.98, 95% confidence interval: 0.97–0.99, P = 0.018). However, the preoperative forced expiratory volume in 1 second (FEV1) (%) and FEV1/FVC (%) were not significantly associated with PPCs (P = 0.059 and P = 0.147, respectively). In conclusion, lower preoperative spirometry FVC, but not FEV1 or FEV1/FVC, may predict PPCs in high-risk patients undergoing laparoscopic abdominal surgery.

Preoperative cardiac and respiratory investigations do not predict cardio‐respiratory complications after pancreatectomy

“…There have been some reports which favour the use of spirometry as a preoperative test, particularly in patients undergoing surgeries such as laparoscopic abdominal, open colorectal or bariatric surgery. [26][27][28] Contrastingly, there is evidence to suggest that spirometry is not a good predictor of perioperative pulmonary complications in patients undergoing laparoscopic gastric surgery. 29 There is a recommendation that preoperative spirometry should be reserved for patients with pre-existing respiratory symptoms or risk factors, such as smoking or dyspnoea.…”

“…The value of preoperative spirometry testing is also controversial. There have been some reports which favour the use of spirometry as a preoperative test, particularly in patients undergoing surgeries such as laparoscopic abdominal, open colorectal or bariatric surgery . Contrastingly, there is evidence to suggest that spirometry is not a good predictor of perioperative pulmonary complications in patients undergoing laparoscopic gastric surgery .…”

Perioperative Pulmonary Support of the Elderly

“…After multivariable logistic regression, it was found that a lower FVC was significantly associated with postoperative pulmonary complications. Also significant were age, surgery duration, and blood transfusion [32]. In addition to the question over its preoperative predictive value, the quality of spirometry has been questioned in advanced age, especially in association with reduced cognition.…”

Predicción de complicaciones pulmonares posoperatorias a través de pruebas de función pulmonar y pruebas cardiopulmonares en pacientes llevados a cirugía no torácica

“…Por otro lado, Tak Kyu Oh, In Sun PArk, Eunjeong y Hyo-Seok, encontraron en un estudio retrospectivo observacional de pacientes mayores de 60 años, fumadores y con historia de enfermedad pulmonar crónica, asociación entre la disminución de la CVF y la aparición de CPP en el contexto de cirugía abdominal laparoscópica, mientras VEF 1 y la relación VEF 1 /CVF no tuvieron relación alguna, por tal motivo consideran la espirometría como un método de estudio importante un mes previo al procedimiento quirúrgico [48]. En pacientes llevados a cirugía ortopédica, no se recomienda la espirometría de rutina, solo en pacientes con síntomas respiratorios inexplicables antes de someterse al procedimiento [49]. En el caso de corrección de escoliosis, la función pulmonar se deterioró en la escoliosis extremadamente grave y en aquellos pacientes con enfermedad pulmonar restrictiva severa [49].…”

“…En pacientes llevados a cirugía ortopédica, no se recomienda la espirometría de rutina, solo en pacientes con síntomas respiratorios inexplicables antes de someterse al procedimiento [49]. En el caso de corrección de escoliosis, la función pulmonar se deterioró en la escoliosis extremadamente grave y en aquellos pacientes con enfermedad pulmonar restrictiva severa [49].…”