THE PREDICTIVE ROLE OF RESPIRATORY MUSCLE FUNCTION ON POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG RESECTION
DOI:
https://doi.org/10.34635/rpc.933Keywords:
Pulmonary surgery, Pulmonary function, Respiratory muscle function, Physical Activity, Postoperative pulmonary complicationsAbstract
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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