Original article
General thoracic
Diffusing Capacity Predicts Morbidity After Lung Resection in Patients Without Obstructive Lung Disease

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.
https://doi.org/10.1016/j.athoracsur.2007.12.071Get rights and content

Background

Diffusing capacity (Dlco), an independent predictor of morbidity after major lung resection, is not used routinely in preoperative evaluation because of a perceived lack of value in patients with normal spirometry. We evaluated the potential utility of measuring Dlco for assessment of operative risk in lung resection patients with normal spirometry.

Methods

A retrospective review was conducted for patients undergoing lung resection from 1980 through 2006 to identify predictors of postoperative morbidity. Patients were divided into groups with or without chronic obstructive lung disease (COPD), defined as a ratio of forced expiratory volume in the first second to forced vital capacity of less than 0.7 or a ratio of 0.7 or greater, respectively. Analyses for each group identified covariates for three outcomes: operative mortality, pulmonary morbidity, and overall morbidity.

Results

Of 1,046 patients in the database, 1,008 (545 men; mean age, 61.8 ± 0.35 years) had data permitting determination of COPD status: 450 (45%) with COPD, 558 (55%) without COPD. Operations included lobectomy (752; 75%), bilobectomy (83; 8%), and pneumonectomy (173; 17%). Overall mortality, pulmonary morbidity, and overall morbidity incidences were 59 (5.8%), 140 (14.0%), and 311 (31.4%), respectively. Pulmonary morbidity and operative mortality were related to postoperative predicted Dlco, age, and performance status in patients with and without COPD. The postoperative predicted Dlco was the single strongest predictor of pulmonary morbidity and operative mortality in both patient groups. Overall complications were related to postoperative predicted Dlco only in the COPD group.

Conclusions

Diffusing capacity is an important predictor of postoperative morbidity after lung resection even in patients with normal spirometry. Routine measurement of Dlco, regardless of spirometric findings, can help predict risk in candidates for major lung resection.

Section snippets

Patients and Methods

We retrospectively reviewed information from our database for all patients undergoing major lung resection (anatomic lobectomy, bilobectomy, pneumonectomy, or completion pneumonectomy) from 1980 through 2006. This protocol was approved by our internal review board, and an exemption was granted for specific patient consent.

Abstracted data included patient demographics; preoperative pulmonary function test results (FEV1 [forced expiratory volume in the first second] expressed as a percent of

Results

During the 1980 to 2006 interval, 1,046 patients underwent major lung resection. Of these, 1,008 had information sufficient to permit assignment to COPD category and form the basis of this study. Patients with COPD were older, had a lower incidence of diabetes mellitus but a higher frequency of prior myocardial infarction, had a higher incidence of unfavorable performance status but less frequently underwent induction therapy, and had substantially worse spirometry and diffusing capacity (Table

Comment

Diffusing capacity of the lung for carbon monoxide was initially investigated in the 1950s and 1960s as a correlate to anatomic changes in the interalveolar septae. Substantially impaired diffusing capacity in patients with emphysema was associated with poor long-term survival [8]. Diffusing capacity subsequently was found to decrease after major lung resection [9, 10, 11, 12], and low Dlco was anecdotally related to an increased risk of operative mortality [13]. In the late 1980s Dlco was

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