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A Clinical Prediction Rule for Pulmonary Complications After Thoracic Surgery for Primary Lung Cancer

David Amar, MD^*, Daisy Munoz, MD^*, Weiji Shi, MS, Hao Zhang, MD^*, and Howard T. Thaler, PhD

From the Departments of *Anesthesiology and Critical Care Medicine, and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.

Address correspondence and reprint requests to David Amar, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Room M-304, New York, NY 10021. Address e-mail to amard{at}mskcc.org.

Abstract

Background: There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery.

Methods: Using a prospective database, we performed an analysis of 956 patients who had resection for lung cancer at a single institution. PC was defined as the occurrence of any of the following: atelectasis, pneumonia, pulmonary embolism, respiratory failure, and need for supplemental oxygen at hospital discharge.

Results: PCs occurred in 121 of 956 patients (12.7%). Preoperative chemotherapy (odds ratio 1.64, 95% confidence interval 1.06–2.55, P = 0.02, point score 2) and a lower DLCOppo (odds ratio per each 5% decrement 1.13, 95% confidence interval 1.06–1.19, P < 0.0001, point score 1 per each 5% decrement of DLCOppo less than 100%) were independent risk factors for PCs. We defined 3 overall risk categories for PCs: low 10 points, 39 of 448 patients (9%); intermediate 11–13 points, 37 of 256 patients (14%); and high 14 points, 42 of 159 patients (26%). The median (range) length of hospital stay was significantly greater for patients who developed PCs than for those who did not: 12 (3–113) days vs 6 (2–39) days, P < 0.0001, respectively. Similarly, 30-day mortality was significantly more frequent for patients who developed PCs than for those who did not: 16 of 121 (13.2%) vs 6 of 835 (0.7%), P < 0.0001.

Conclusions: These data show that PCs after thoracic surgery for lung cancer can be predicted with moderate accuracy based on DLCOppo and whether patients had chemotherapy. Forced expired volume in 1 s was not a predictor of PCs.