THE PREDICTIVE ROLE OF RESPIRATORY MUSCLE FUNCTION ON POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG RESECTION
Abstract
Background: Preoperative evaluation before pulmonary surgery typically do not include the assessment of respiratory muscle function, which might be a predictor of postoperative pulmonary complications (PPC).
Objectives: To ascertain whether preoperative respiratory muscle function predicts PPC in patients submitted to pulmonary resection by thoracotomy.
Methods: Beyond pulmonary and respiratory muscle functions assessments, physical fitness was evaluated with the 6-minute walking test. We registered PPC occurring up to 30 days after hospital discharge. Discriminant function analysis was carried out to identify which variables were the best predictors of PPC. Logistic regression was used to analyse associations between variables of respiratory muscle function and PPC.
Results: Patients with PPC (n=20), compared to those without PPC (n=85), had significant heavy smoking habits (t=-2.412; p=0.027; d=0.547), decreased forced expiratory volume in the first second (FEV1; t=-2.932; p=0.004; d=0.703), peak expiratory flow (PEF; t=-2.412; p=0.018; d=0.586), diffusion capacity for carbon monoxide (DLCO; t=2.183; p=0.039; d=0.673). Regarding respiratory muscle function, maximal expiratory pressure was significantly reduced in patients with PPC (MEP; t=3.116; p=0.002; d=0.744). Discriminant function structural coefficients showed that MEP % (-0.519), FEV1 % (-0.488), DLCO % (-0.465), PEF % (-0.402) and cigarettes pack-year (0.374) were the most important factors to discriminate groups with and without PPC. Results from logistic regression indicate that those patients with lower MEP (%) have an increased risk of PPC (OR=7.440; 95% CI= 1.228 – 19.471).
Conclusion: Preoperative maximal expiratory pressure was the strongest predictor of PPC and should be considered for risk assessment in surgical candidates.
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References
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34. Wyser C, Stulz P, Soler M, Tamm M, Muller-Brand J, Habicht J, Perruchoud AP, Bolliger CT: Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit Care Med 1999, 159(5 Pt 1):1450-1456.
35. Lange P, Vestbo J: Chronic Mucus Hypersecretion and the Natural History of Chronic Obstructive Pulmonary Disease. 2016, 193(6):602.
36. Terzano C, Ceccarelli D, Conti V, Graziani E, Ricci A, Petroianni A: Maximal respiratory static pressures in patients with different stages of COPD severity. Respir Res 2008, 9:8.
37. Ramírez-Sarmiento A, Orozco-Levi M, Barreiro E, Méndez R, Ferrer A, Broquetas J, Geo J: Expiratory muscle endurance in chronic obstructive pulmonary disease. Thorax 2002, 57(2):132.
38. Vilaró J, Ramirez-Sarmiento A, Martínez-Llorens JM, Mendoza T, Alvarez M, Sánchez-Cayado N, Vega Á, Gimeno E, Coronell C, Gea J et al: Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations. Respiratory Medicine 2010, 104(12):1896-1902.
39. Lee H, Kim HK, Kang D, Kong S, Lee JK, Lee G, Shin S, Cho J, Zo JI, Shim YM et al: Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer. Chest 2020, 157(6):1665-1673.
2. Kendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT: Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disabil Rehabil 2018, 40(8):864-882.
3. Varela G, Novoa NM, Ballesteros E, Agostini P: Chest Physiotherapy in Lung Resection Patients: State of the Art. Seminars in Thoracic and Cardiovascular Surgery 2011, 23(4):297-306.
4. Ceppa DP, Kosinski AS, Berry MF, Tong BC, Harpole DH, Mitchell JD, D’Amico TA, Onaitis MW: Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. 2012, 256(3):487.
5. Varela G, Jimenez MF, Novoa N, Aranda JL: Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005, 27(2):329-333.
6. Varela G, Ballesteros E, Jimenez MF, Novoa N, Aranda JL: Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg 2006, 29(2):216-220.
7. Kim ES, Kim YT, Kang CH, Park IK, Bae W, Choi SM, Lee J, Park YS, Lee CH, Lee SM et al: Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis 2016, 11:1317-1326.
8. Mazo V, Sabate S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P: Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 2014, 121(2):219-231.
9. Kupeli E, Er Dedekarginoglu B, Ulubay G, Oner Eyuboglu F, Haberal M: American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant. Exp Clin Transplant 2017, 15(Suppl 1):208-213.
10. Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, Licker M, Ferguson MK, Faivre-Finn C, Huber RM et al: ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 2009, 34(1):17-41.
11. Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM: Executive Summary. Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2013, 143(5):7S.
12. Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P: The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. Rev Port Pneumol 2017, 23(6):343-351.
13. Brunelli A, Salati M, Rocco G, Varela G, Van Raemdonck D, Decaluwe H, Falcoz PE: European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database†,‡. 2016.
14. Miskovic A, Lumb AB: Postoperative pulmonary complications. Br J Anaesth 2017, 118(3):317-334.
15. Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F: Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. Jornal Brasileiro de Pneumologia 2008, 34(12):1008-1018.
16. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA: Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999, 54(7):581-586.
17. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P et al: Standardisation of spirometry. Eur Respir J 2005, 26(2):319-338.
18. American Thoracic Society/European Respiratory S: ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002, 166(4):518-624.
19. Laboratories ATSCoPSfCPF: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002, 166(1):111-117.
20. Tabachnik BG, Fidell LS: Using multivariate statistics. New York: HarperCollins; 1996.
21. Mota S, Guell R, Barreiro E, Solanes I, Ramirez-Sarmiento A, Orozco-Levi M, Casan P, Gea J, Sanchis J: Clinical outcomes of expiratory muscle training in severe COPD patients. Respir Med 2007, 101(3):516-524.
22. Bernard A, Brondel L, Arnal E, Favre JP: Evaluation of respiratory muscle strength by randomized controlled trial comparing thoracoscopy, transaxillary thoracotomy, and posterolateral thoracotomy for lung biopsy. Eur J Cardiothorac Surg 2006, 29(4):596-600.
23. Nomori H, Horio H, Fuyuno G, Kobayashi R, Yashima H: Respiratory muscle strength after lung resection with special reference to age and procedures of thoracotomy. Eur J Cardiothorac Surg 1996, 10(5):352-358.
24. Brocki BC, Andreasen JJ, Langer D, Souza DS, Westerdahl E: Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2016, 49(5):1483-1491.
25. Polla B, D’Antona G, Bottinelli R, Reggiani C: Respiratory muscle fibres: specialisation and plasticity. Thorax 2004, 59(9):808-817.
26. Postiaux G: Série « Les voies aériennes distales dans la BPCO »: La kinésithérapie respiratoire du poumon profond. Bases mécaniques d’un nouveau paradigme. Rev Mal Respir 2014, 31(6):552.
27. McIlwaine M, Bradley J, Elborn JS, Moran F: Personalising airway clearance in chronic lung disease. Eur Respir Rev 2017, 26(143).
28. Mans CM, Reeve JC, Elkins MR: Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clin Rehabil 2015;29(5):426-38 2014.
29. Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA: Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev 2015, 10:CD010356.
30. Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ: Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest 2013, 132(3):161S-177S.
31. Brunelli A: Risk assessment for pulmonary resection. Semin Thorac Cardiovasc Surg 2010, 22(1):2-13.
32. Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF: Peak expiratory flow: conclusions and recommendations of a Working Party of the European Respiratory Society. Eur Respir J Suppl 1997, 24:2S-8S.
33. Lai Y, Wang X, Li P, Li J, Zhou K, Che G: Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases. J Thorac Dis 2018, 10(7):4293-4301.
34. Wyser C, Stulz P, Soler M, Tamm M, Muller-Brand J, Habicht J, Perruchoud AP, Bolliger CT: Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit Care Med 1999, 159(5 Pt 1):1450-1456.
35. Lange P, Vestbo J: Chronic Mucus Hypersecretion and the Natural History of Chronic Obstructive Pulmonary Disease. 2016, 193(6):602.
36. Terzano C, Ceccarelli D, Conti V, Graziani E, Ricci A, Petroianni A: Maximal respiratory static pressures in patients with different stages of COPD severity. Respir Res 2008, 9:8.
37. Ramírez-Sarmiento A, Orozco-Levi M, Barreiro E, Méndez R, Ferrer A, Broquetas J, Geo J: Expiratory muscle endurance in chronic obstructive pulmonary disease. Thorax 2002, 57(2):132.
38. Vilaró J, Ramirez-Sarmiento A, Martínez-Llorens JM, Mendoza T, Alvarez M, Sánchez-Cayado N, Vega Á, Gimeno E, Coronell C, Gea J et al: Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations. Respiratory Medicine 2010, 104(12):1896-1902.
39. Lee H, Kim HK, Kang D, Kong S, Lee JK, Lee G, Shin S, Cho J, Zo JI, Shim YM et al: Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer. Chest 2020, 157(6):1665-1673.
Published
2022-02-02
How to Cite
KENDAL, Filipa et al.
THE PREDICTIVE ROLE OF RESPIRATORY MUSCLE FUNCTION ON POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG RESECTION.
Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 63-73, feb. 2022.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/933>. Date accessed: 03 oct. 2023.
doi: https://doi.org/10.34635/rpc.933.
Section
Original Papers
