Preoperative assessment of the thoracic surgery patient: pulmonary function testing

Acute and chronic reduction of pulmonary function after lung surgery

Pulmonary function is affected by several variables. The more marginal the patient, the more important the preoperative and perioperative assessment becomes. VATS might be tolerated well with regard to pulmonary function in the early postoperative period. It has allowed thoracic surgeons to expand surgical indications to patients that previously would not have been considered.

Improved outcomes with early vocal fold medialization for vocal fold paralysis after thoracic surgery

OBJECTIVE

To determine the clinical impact of early versus late surgical therapy for new onset unilateral vocal cord paralysis (UVCP) after thoracic surgery.

STUDY DESIGN

Patients diagnosed with new onset UVCP after esophagectomy, pneumonectomy or pulmonary lobectomy were reviewed to determine the incidence of pneumonia, need for postoperative bronchoscopy and length of stay (LOS). Comparisons were made between patients undergoing early (< or = 4 days after thoracic procedure) versus late rehabilitation (> or = 5 days after thoracic procedure) of their UVCP with vocal cord medialization.

RESULTS

Some 86 patients (27 esophagectomies, 43 pneumonectomies and 16 lobectomies) with new onset UVCP were examined. A total of 32 patients (37.2%) underwent early vocal cord medialization and 54 (62.8%) underwent late repair. The pneumonia rate for patients undergoing early vocal cord medialization (6.3%) was significantly lower than the rate for vocal cord medialization (37.0%, P=0.001, chi(2)). Early medialization patients required fewer postoperative bronchoscopies (mean number of bronchoscopies, 0.26) than late medialization patients (mean bronchoscopies, 0.94, P=0.013). The median LOS was significantly decreased for early versus late medialization patients in both pneumonectomy (reduction in LOS of 8 days) and lobectomy groups (reduction in LOS of 7 days).

CONCLUSIONS

Early vocal cord medialization decreases the pneumonia rate, the requirement for postoperative bronchoscopies and the LOS for patients suffering from new onset UVCP after thoracic surgery.

SIGNIFICANCE

Consideration should be given to early medialization for new onset UVCP when medically sound.