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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 894-900, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MK Ferguson, L Little, L Rizzo, KJ Popovich, GF Glonek, A Leff, D Manjoney and AG Little
Patients who are considered for major pulmonary resection are normally
evaluated by spirometry and clinical assessment. Despite this, the
morbidity and mortality rates are high after these operations. We
retrospectively reviewed results of lung resection performed during a
period of 7.5 years in 237 patients to identify other important predictors
of morbidity and mortality. There were 144 male and 93 female patients with
a mean age of 59.4 +/- 11.4 years. The indication for operation was lung
cancer in 199 (76 stage I, 34 stage II, 89 stage IIIA-B), benign disease in
34, and metastatic disease from other primary tumors in four. Lobectomy or
bilobectomy was performed in 164 patients and pneumonectomy in 73. Data on
38 preoperative and operative risk factors were correlated with information
on 24 postoperative events grouped into four major categories: death,
pulmonary complications, cardiovascular complications, and other problems.
Logistic regression analysis and chi 2 analysis were used to identify the
relationship of the preoperative risk factors to the grouped postoperative
complications. The diffusing capacity of the lung for carbon monoxide was
the most important predictor of mortality (p less 0.01) and was the sole
predictor of postoperative pulmonary complications (p less than 0.005).
This diffusing capacity can reveal the existence of emphysematous changes
in the lung, even when spirometric values are acceptable, and it usually
should be a part of the evaluation of patients being considered for
pulmonary resection.
ARTICLES
Diffusing capacity predicts morbidity and mortality after pulmonary resection
Department of Surgery, University of Chicago Medical Center, Ill 60637.
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G. L. Walsh, R. C. Morice, J. B. Putnam Jr, J. C. Nesbitt, M. J. McMurtrey, M. B. Ryan, J. M. Reising, K. M. Willis, J. D. Morton, and J. A. Roth Resection of lung cancer is justified in high-risk patients selected by exercise oxygen consumption Ann. Thorac. Surg., September 1, 1994; 58(3): 704 - 711. [Abstract] [PDF]
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