Predictive value of preoperative pulmonary function test indexes for postoperative pneumonia in patients undergoing upper gastrointestinal surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Shiqi ¹ , LIU Yuwei ² , LIN lin ³ ,  LI Ka ¹

1. West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. West China School of Nursing, Sichuan University/Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. West China School of Nursing, Sichuan University/Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LI Ka, Email: likalika127127@163.com

Keywords：

Upper gastrointestinal surgery; pulmonary function test; postoperative pneumonia; prediction

DOI：

10.7507/1007-4848.202103087

Video：

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Objective To analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia (POP) in patients undergoing upper gastrointestinal surgery.Methods The clinical data of 303 patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital, Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed. There were 217 males and 86 females, with an average age of 61.61±10.42 years. Pulmonary function was evaluated from four aspects including ventilatory function, pulmonary volume, diffusion function and airway resistance. Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value (%pred). The outcome index was pneumonia within 30 days after the surgery. Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.Results A total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included, and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7% (81/303). Patients with preoperative low peak expiratory flow (PEF%pred) had a 3.094 times higher risk of developing POP than those with normal PEF%pred [OR=3.094, 95%CI (1.362, 7.032), P=0.007]. The incidence of POP had no correlation with the other preoperative indicators.Conclusion Preoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.

Citation： LIANG Shiqi, LIU Yuwei, LIN lin, LI Ka. Predictive value of preoperative pulmonary function test indexes for postoperative pneumonia in patients undergoing upper gastrointestinal surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 923-929. doi: 10.7507/1007-4848.202103087 Copy

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2.	Wren SM, Martin M, Yoon JK, et al. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg, 2010, 210(4): 491-495.
3.	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5): 948-968.
4.	Skloot GS. The effects of aging on lung structure and function. Clin Geriatr Med, 2017, 33(4): 447-457.
5.	侯海生, 王秋艳, 陈少川. 食管癌开胸术患者术后肺部感染与术前肺功能指标的相关性. 国际肿瘤学杂志, 2019, 46(8): 471-474.
6.	Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
7.	Oh TK, Park IS, Ji E, et al. Value of preoperative spirometry test in predicting postoperative pulmonary complications in high-risk patients after laparoscopic abdominal surgery. PLoS One, 2018, 13(12): e0209347.
8.	Hattori K, Matsuda T, Takagi Y, et al. Preoperative six-minute walk distance is associated with pneumonia after lung resection. Interact Cardiovasc Thorac Surg, 2018, 26(2): 277-283.
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11.	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第二部分)—肺量计检查. 中华结核和呼吸杂志, 2014, 37(7): 481-486.
12.	Bhatt SP, Balte PP, Schwartz JE, et al. Discriminative accuracy of FEV1: FVC thresholds for COPD-related hospitalization and mortality. JAMA, 2019, 321(24): 2438-2447.
13.	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—肺容量检查. 中华结核和呼吸杂志, 2015, 38(4): 255-260.
14.	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—体积描记法肺容量和气道阻力检查. 中华结核和呼吸杂志, 2015, 38(5): 342-347.
15.	Huang TS, Hu FC, Fan CW, et al. A simple novel model to predict hospital mortality, surgical site infection, and pneumonia in elderly patients undergoing operation. Dig Surg, 2010, 27(3): 224-231.
16.	Sunpaweravong S, Ruangsin S, Laohawiriyakamol S, et al. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg, 2012, 35(3): 104-109.
17.	张维汉, 陈心足, 杨昆, 等. 胃癌术后肺部并发症相关危险因素分析. 中国实用外科杂志, 2017, 37(4): 432-436.
18.	周坤, 吴砚铭, 苏建华, 等. 肺癌患者术前呼气峰流速可以预测肺叶切除术后肺部并发症吗? 中国肺癌杂志, 2017, 20(9): 603-609.
19.	Lutchmedial SM, Creed WG, Moore AJ, et al. How common is airflow limitation in patients with emphysema on CT scan of the chest? Chest, 2015, 148(1): 176-184.
20.	Aguilera LG, Gallart L, Álvarez JC, et al. Rectal, central venous, gastric and bladder pressures versus esophageal pressure for the measurement of cough strength: A prospective clinical comparison. Respir Res, 2018, 19(1): 191.
21.	Berry MF, Villamizar-Ortiz NR, Tong BC, et al. Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. Ann Thorac Surg, 2010, 89(4): 1044-1051.
22.	Bellia V, Sorino C, Catalano F, et al. Validation of FEV6 in the elderly: Correlates of performance and repeatability. Thorax, 2008, 63(1): 60-66.
23.	Yokota S, Koizumi M, Togashi K, et al. Preoperative pulmonary function tests do not predict the development of pulmonary complications after elective major abdominal surgery: A prospective cohort study. Int J Surg, 2020, 73: 65-71.
24.	Inokuchi M, Kojima K, Kato K, et al. Risk factors for post-operative pulmonary complications after gastrectomy for gastric cancer. Surg Infect (Larchmt), 2014, 15(3): 314-321.
25.	Tajima Y, Tsuruta M, Yahagi M, et al. Is preoperative spirometry a predictive marker for postoperative complications after colorectal cancer surgery? Jpn J Clin Oncol, 2017, 47(9): 815-819.
26.	Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 161S-77S.
27.	Brunelli A, Tentzeris V, Sandri A, et al. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme. Eur J Cardiothorac Surg, 2016, 49(5): 1492-1496.
28.	Karayama M, Inui N, Mori K, et al. Respiratory impedance is correlated with morphological changes in the lungs on three-dimensional CT in patients with COPD. Sci Rep, 2017, 7: 41709.
29.	Qiu Q, Duan J, Deng H, et al. Development and validation of a radiomics nomogram model for predicting postoperative recurrence in patients with esophageal squamous cell cancer who achieved pCR after neoadjuvant chemoradiotherapy followed by surgery. Front Oncol, 2020, 10: 1398.
30.	Bai Y, Wei C, Zhong Y, et al. Development and validation of a prognostic nomogram for gastric cancer based on DNA methylation-driven differentially expressed genes. Int J Biol Sci, 2020, 16(7): 1153-1165.
31.	周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.

1. Kazaure HS, Martin M, Yoon JK, et al. Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward. JAMA Surg, 2014, 149(9): 914-918.
2. Wren SM, Martin M, Yoon JK, et al. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg, 2010, 210(4): 491-495.
3. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5): 948-968.
4. Skloot GS. The effects of aging on lung structure and function. Clin Geriatr Med, 2017, 33(4): 447-457.
5. 侯海生, 王秋艳, 陈少川. 食管癌开胸术患者术后肺部感染与术前肺功能指标的相关性. 国际肿瘤学杂志, 2019, 46(8): 471-474.
6. Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
7. Oh TK, Park IS, Ji E, et al. Value of preoperative spirometry test in predicting postoperative pulmonary complications in high-risk patients after laparoscopic abdominal surgery. PLoS One, 2018, 13(12): e0209347.
8. Hattori K, Matsuda T, Takagi Y, et al. Preoperative six-minute walk distance is associated with pneumonia after lung resection. Interact Cardiovasc Thorac Surg, 2018, 26(2): 277-283.
9. 中华人民共和国卫生部. 肺炎诊断 (WS 382-2012). 北京: 中国标准出版社, 2012.
10. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—肺弥散功能检查. 中华结核和呼吸杂志, 2015, 38(3): 164-169.
11. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第二部分)—肺量计检查. 中华结核和呼吸杂志, 2014, 37(7): 481-486.
12. Bhatt SP, Balte PP, Schwartz JE, et al. Discriminative accuracy of FEV1: FVC thresholds for COPD-related hospitalization and mortality. JAMA, 2019, 321(24): 2438-2447.
13. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—肺容量检查. 中华结核和呼吸杂志, 2015, 38(4): 255-260.
14. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南—体积描记法肺容量和气道阻力检查. 中华结核和呼吸杂志, 2015, 38(5): 342-347.
15. Huang TS, Hu FC, Fan CW, et al. A simple novel model to predict hospital mortality, surgical site infection, and pneumonia in elderly patients undergoing operation. Dig Surg, 2010, 27(3): 224-231.
16. Sunpaweravong S, Ruangsin S, Laohawiriyakamol S, et al. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg, 2012, 35(3): 104-109.
17. 张维汉, 陈心足, 杨昆, 等. 胃癌术后肺部并发症相关危险因素分析. 中国实用外科杂志, 2017, 37(4): 432-436.
18. 周坤, 吴砚铭, 苏建华, 等. 肺癌患者术前呼气峰流速可以预测肺叶切除术后肺部并发症吗? 中国肺癌杂志, 2017, 20(9): 603-609.
19. Lutchmedial SM, Creed WG, Moore AJ, et al. How common is airflow limitation in patients with emphysema on CT scan of the chest? Chest, 2015, 148(1): 176-184.
20. Aguilera LG, Gallart L, Álvarez JC, et al. Rectal, central venous, gastric and bladder pressures versus esophageal pressure for the measurement of cough strength: A prospective clinical comparison. Respir Res, 2018, 19(1): 191.
21. Berry MF, Villamizar-Ortiz NR, Tong BC, et al. Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. Ann Thorac Surg, 2010, 89(4): 1044-1051.
22. Bellia V, Sorino C, Catalano F, et al. Validation of FEV6 in the elderly: Correlates of performance and repeatability. Thorax, 2008, 63(1): 60-66.
23. Yokota S, Koizumi M, Togashi K, et al. Preoperative pulmonary function tests do not predict the development of pulmonary complications after elective major abdominal surgery: A prospective cohort study. Int J Surg, 2020, 73: 65-71.
24. Inokuchi M, Kojima K, Kato K, et al. Risk factors for post-operative pulmonary complications after gastrectomy for gastric cancer. Surg Infect (Larchmt), 2014, 15(3): 314-321.
25. Tajima Y, Tsuruta M, Yahagi M, et al. Is preoperative spirometry a predictive marker for postoperative complications after colorectal cancer surgery? Jpn J Clin Oncol, 2017, 47(9): 815-819.
26. Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 161S-77S.
27. Brunelli A, Tentzeris V, Sandri A, et al. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme. Eur J Cardiothorac Surg, 2016, 49(5): 1492-1496.
28. Karayama M, Inui N, Mori K, et al. Respiratory impedance is correlated with morphological changes in the lungs on three-dimensional CT in patients with COPD. Sci Rep, 2017, 7: 41709.
29. Qiu Q, Duan J, Deng H, et al. Development and validation of a radiomics nomogram model for predicting postoperative recurrence in patients with esophageal squamous cell cancer who achieved pCR after neoadjuvant chemoradiotherapy followed by surgery. Front Oncol, 2020, 10: 1398.
30. Bai Y, Wei C, Zhong Y, et al. Development and validation of a prognostic nomogram for gastric cancer based on DNA methylation-driven differentially expressed genes. Int J Biol Sci, 2020, 16(7): 1153-1165.
31. 周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of preoperative pulmonary function test indexes for postoperative pneumonia in patients undergoing upper gastrointestinal surgery

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