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Titolo:
EXERCISE CAPACITY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN LUNG RESECTION CANDIDATES
Autore:
BOLLIGER CT; JORDAN P; SOLER M; STULZ P; GRADEL E; SKARVAN K; ELSASSER S; GONON M; WYSER C; TAMM M; PERRUCHOUD AP;
Indirizzi:
UNIV BASEL HOSP,DEPT INTERNAL MED,DIV PNEUMOL,PETERSGRABEN 4 CH-4031 BASEL SWITZERLAND UNIV BASEL HOSP,UNIV COMP CTR CH-4031 BASEL SWITZERLAND UNIV BASEL HOSP,DEPT SURG,CARDIOTHORAC UNIT CH-4031 BASEL SWITZERLAND UNIV BASEL HOSP,DEPT ANESTHESIOL CH-4031 BASEL SWITZERLAND
Titolo Testata:
American journal of respiratory and critical care medicine
fascicolo: 5, volume: 151, anno: 1995,
pagine: 1472 - 1480
SICI:
1073-449X(1995)151:5<1472:ECAAPO>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
PULMONARY RESECTION; OXYGEN-CONSUMPTION; HIGH-RISK; MORBIDITY; MORTALITY; INDEX;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
27
Recensione:
Indirizzi per estratti:
Citazione:
C.T. Bolliger et al., "EXERCISE CAPACITY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN LUNG RESECTION CANDIDATES", American journal of respiratory and critical care medicine, 151(5), 1995, pp. 1472-1480

Abstract

Exercise testing with measurement of maximal oxygen uptake (VO(2)max)is increasingly used in the assessment of lung resection candidates, but its predictive value for postoperative complications remains controversial. We therefore sought to determine the prognostic value of VO(2)max compared with other pulmonary function tests. A consecutive group of 80 patients (mean age 61 yr; 57 males and 23 females) scheduled for lung resection (62 malignancies, 12 benign disorders, and 6 carcinoids) underwent pulmonary function tests and symptom-limited cycle ergometry. All patients underwent lung resections: 21 pneumonectomies, 45 lobectomies, and 14 segmental or wedge resections. Group A (64 patients, 80%) had an uneventful postoperative course, whereas Group B (16 patients, 20%) had complications; 3 of them died (4% overall mortality rate). In a stepwise logistic regression analysis used to determine independent risk factors for postoperative complications (within 30 d), VO(2)max expressed as a percentage of predicted (84 +/- 19 for Group A versus 61 +/- 11 for Group B) proved to be the best predictor (predictive value 85.5%). Although VO(2)max expressed in absolute values (ml/kg/min) was also highly predictive (79.5%), a ROC curve analysis provedthe percentage predicted values to be significantly more sensitive. Of 9 patients with a VO(2)max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity 50%, specificity 98%). The estimated probability (probit model SAS software package) of suffering no complication was 0.9 for VO(2)max > 75% of predicted and 0.1 for a VO(2)max < 43%. We conclude that exercise testing was a valuable tool and VO(2)max expressed as a percentage of predicted was the single best indicator of postoperative complications after lung resection. A cutoff value < 60% of predicted was highly predictive of complications and probably prohibitive forresections involving more than one lobe, whereas a VO(2)max value > 75% of predicted was an excellent indicator of an uneventful postoperative course irrespective of the extent of resection.

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Documento generato il 04/12/20 alle ore 16:25:59