Predictors of delayed extubation following lung resection: Focusing on preoperative pulmonary function and incentive spirometry

Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study

INTRODUCTION

Patients with a mediastinal mass are at risk of pulmonary complications in the perioperative period. Preoperative spirometry tests are recommended in patients scheduled for thoracic surgery. Our objective is to investigate the association between preoperative spirometry results and the incidence of postoperative pulmonary complications in patients following mediastinal mass resection, which may determine the usefulness of spirometry tests in the prediction of the perioperative respiratory risk.

METHODS AND ANALYSIS

This protocol describes a retrospective cohort study of patients with mediastinal masses in Shanghai Pulmonary Hospital between 1 September 2021 and 1 September 2022, with a planned sample size of 660 patients. The primary aim of this study is to explore the association between preoperative spirometry results and the occurrence of postoperative pulmonary complications after mediastinal mass resection. Logistic regression analysis will be used to calculate the adjusted incidence rate difference and incidence rate ratios (with 95% CIs).

ETHICS AND DISSEMINATION

The study was approved by the ethics committee of Shanghai Pulmonary Hospital (K21-372Y). The results of the study will be submitted to a peer-reviewed biomedical journal for publication and presented at relevant conferences.

Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study

Background

This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection.

Methods

We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias.

Results

Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching.

Conclusions

Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01836-w.

Chronic obstructive pulmonary disease assessment test for the measurement of deterioration and recovery of health status of patients undergoing lung surgery

Background

Patients with early lung cancer often undergo surgery. However, surgery usually results in a decline in health‐related quality of life (HRQL). Several questionnaires have previously been used to assess HRQL but some are impractical for clinical use. The chronic obstructive pulmonary disease assessment test (CAT) is simple and has been widely used in respiratory diseases but not for lung cancer. We therefore conducted this study to clarify the role of the CAT in postoperative deterioration and recovery of HRQL.

Methods

Fifty‐five patients who underwent lung resection were recruited into the study. Cardiopulmonary exercise tests and respiratory muscle strength were performed 1 week before surgery (pre‐OP) and at post‐OP 1 month. HRQL was assessed through the CAT and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ‐C30) 1 week pre‐OP and post‐OP 1 and at 2 months.

Results

Fifteen (27.3%) patients underwent wedge resection, four (7.3%) underwent segmentectomy, and 36 (65.5%) underwent lobectomy. After lobectomy, exercise capacity decreased significantly. The deterioration of CAT symptoms (cough, phlegm, chest tightness, dyspnea, activity, confidence, sleep disturbance, and lack of energy) was more prominent in patients who had undergone lobectomy than wedge resection. Based on the EORTC QLQ‐C30, physical, role function, fatigue, pain, sleep disturbance, dyspnea, and global health status worsened significantly, whereas there was no significant difference in other symptoms. HRQL recovered at post‐OP 2 months in patients who had undergone wedge resection but not lobectomy.

Conclusions

Postoperative HRQL and exercise capacity in patients were significantly reduced, especially those who had undergone lobectomy. The CAT significantly reflected postoperative changes in HRQL.

Efficacy of Incentive Spirometer in Increasing Maximum Inspiratory Volume in an Out-Patient Setting

Background

Incentive spirometry (IS) is the mainstay of care in postoperative patients that has been heavily studied in the inpatient setting. Studies have shown that the utilization of IS improves lung volumes and reduces the rate of pneumonia in post-surgical patients. However, the literature is ambiguous on its benefit as many studies also demonstrate no significant benefit, especially in comparison to early ambulation. Our study sought to determine whether a consistent IS regimen can improve lung function in an outpatient setting.

Methods

This prospective cohort study included patients in a physical medicine and rehabilitation clinic setting during the COVID pandemic. Patients with severe respiratory disease, baseline cough, those unable to perform deep breathing, fever greater than 100.4 F due to non-pulmonary on initial evaluation, or inability to fill out the forms and complete the study were excluded. Each participant was given the IS along with hands-on instruction on how to use the device and accurately record measurements. Patients were asked to lie down and inhale and exhale through the tube ten times. They were asked to mark the highest volume during their 10 breaths. Patients were instructed to complete this exercise three times a day for 30 days. Patients were also asked to perform light exercises or walking for 20 minutes per day three times a week and postural drainage. Patients were instructed to call their primary care physician if a 20% or more decrease from their baseline was noted or if they experienced any new coughs, fever, or shortness of breath during the 30 days of exercise.

Results

A total of 48 patients enrolled in the study with a (median) age of 58.0 years (SD 10.2 years), 21 females and 27 males. Baseline maximal inspiration for study participants was 1885.4 mL prior to exercise, with a subsequent increase in lung capacity observed for all participants enrolled in the study. At the end of the study period, week four, the average maximal inspiratory volume was 2235.4 mL. Paired t-test showed a significant difference between baseline (1885.4) and maximum (2235.4) volumes (t=-4.59, p<0.0001). Analysis of variance (ANOVA) showed no significant difference among Week 1-4 averages (F=1.08, p=0.36). None of the participants reported any symptoms (fever, coughing, shortness of breath) or COVID-19 infection during the 30-days period. None of the participants reported contacting primary care physicians. 

Conclusion

When prescribed daily breathing exercises with an incentive spirometer, study participants experienced a 16% increase in maximal inspiratory volume over a span of 30 days and did not need to contact their primary care physician during the study period.