TY - JOUR
T1 - Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection
AU - Varela, Gonzalo
AU - Brunelli, Alessandro
AU - Rocco, Gaetano
AU - Novoa, Nuria
AU - Refai, Majed
AU - Jiménez, Marcelo F.
AU - Salati, Michele
AU - Gatani, Tindaro
PY - 2007/3
Y1 - 2007/3
N2 - Introduction and objective: There is a low correlation between predicted postoperative FEV1 (ppoFEV1) and FEV1 measured the days after pulmonary resection, when most complications are developed. The hypothesis of this investigation is that ppoFEV1 does not predict postoperative morbidity in patients undergoing lung resection when immediate postoperative FEV1 is considered in the predictive model. Methods: One hundred ninety-eight consecutive patients undergoing lobectomy or pneumonectomy were included in a prospective, multiinstitutional study. Independent variables: age, body mass index, ppoFEV1, surgical approach (VATS or muscle-sparing thoracotomy), type of analgesia (epidural or intraveous), postoperative visual analogue pain score and FEV1 measured the day after the operation. Target variable: occurrence of postoperative cardio-respiratory complications. Method of analysis: classification tree (CART) dividing the population at random in two subsets and developing a bootstrap set of 100 trees resampling training data. The relative importance of each variable and the accuracy of both initial and committee trees to predict the outcome were presented. Results: One hundred seventy-seven lobectomies and 21 pneumonectomies were included. Overall cardio-respiratory morbidity was 22%. According to CART results, first day FEV1 was the most important variable to classify cases as primary splitter and as a surrogate of each primary splitter (100% importance). Patient age followed (51%) and ppoFEV1 was third (43%) with a score similar to postoperative pain score (42%) and type of analgesia (36%). Sensitivity and specificity of the initial tree were, respectively, 0.5 and 0.7; values for committee tree were 0.5 sensitivity and 0.7 specificity. Conclusion: Postoperative cardio-respiratory complications are more related to FEV1 measured in the first postoperative day than to ppoFEV1 value.
AB - Introduction and objective: There is a low correlation between predicted postoperative FEV1 (ppoFEV1) and FEV1 measured the days after pulmonary resection, when most complications are developed. The hypothesis of this investigation is that ppoFEV1 does not predict postoperative morbidity in patients undergoing lung resection when immediate postoperative FEV1 is considered in the predictive model. Methods: One hundred ninety-eight consecutive patients undergoing lobectomy or pneumonectomy were included in a prospective, multiinstitutional study. Independent variables: age, body mass index, ppoFEV1, surgical approach (VATS or muscle-sparing thoracotomy), type of analgesia (epidural or intraveous), postoperative visual analogue pain score and FEV1 measured the day after the operation. Target variable: occurrence of postoperative cardio-respiratory complications. Method of analysis: classification tree (CART) dividing the population at random in two subsets and developing a bootstrap set of 100 trees resampling training data. The relative importance of each variable and the accuracy of both initial and committee trees to predict the outcome were presented. Results: One hundred seventy-seven lobectomies and 21 pneumonectomies were included. Overall cardio-respiratory morbidity was 22%. According to CART results, first day FEV1 was the most important variable to classify cases as primary splitter and as a surrogate of each primary splitter (100% importance). Patient age followed (51%) and ppoFEV1 was third (43%) with a score similar to postoperative pain score (42%) and type of analgesia (36%). Sensitivity and specificity of the initial tree were, respectively, 0.5 and 0.7; values for committee tree were 0.5 sensitivity and 0.7 specificity. Conclusion: Postoperative cardio-respiratory complications are more related to FEV1 measured in the first postoperative day than to ppoFEV1 value.
KW - Classification and regression trees
KW - Lung volume measurements
KW - Postoperative care
KW - Postoperative pain
KW - Thoracic surgical procedures
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U2 - 10.1016/j.ejcts.2006.11.036
DO - 10.1016/j.ejcts.2006.11.036
M3 - Article
C2 - 17188886
AN - SCOPUS:33847295271
VL - 31
SP - 518
EP - 521
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 3
ER -