To explore the optimal cutoff value of EDs for predicting PPC and verify whether EDs can predict PPC after lung resection surgery.
This single-center, retrospective, observational study included 169 patients who underwent lung resection surgery for neoplastic lung disease between October 2017 and March 2023 and received perioperative physical therapy. The SpO2 before the start of the 6MWT was used as the baseline value. Change in SpO2 within 1 min of the start of the 6MWT was defined as ΔSpO2, which was used as the variable for EDs. PPC was defined as occurring during hospitalization after lung resection surgery, and its severity was defined using the Clavien-Dindo classification (CD). For statistical analysis, a cut-off value of ΔSpO2 was calculated with Youden's index from the Receiver Operating Characteristic curve to identify the optimal cutoff value for EDs, To verify the predictive ability of EDs for PPC, EDs were divided into two groups by the cut-off value, and univariable logistic regression analysis was performed. In addition, multivariable logistic regression analysis was performed using the EDs and PPC risk factors reported in previous studies as independent variables, and the PPC risk factors were age, sex, smoking history, and FEV1.0/FVC. The predictive accuracy of the constructed model was measured using the area under the curve (AUC).
In total, 149 patients were included in the final analysis. PPC were observed in 29 (19%) patients. CD (I, 10 (35%); II, 6 (21%); IIIa, 12 (41%); IIIb, 1 (3% ). The optimal cutoff value was ΔSpO2 -1.8% (AUC, 0.65; 95% confidence interval (CI), 0.53-0.76), and EDs had PPC predictive ability (odds ratio (OR), 5.36; 95% CI, 2.25-13, p=0.0002). In multivariable logistic regression analysis, EDs was an independent predictor of PPC (OR, 7.77; 95% CI, 2.7-24.6, p=0.0001). The predictive accuracy of the constructed model was (AUC, 0.83; 95% CI, 0.72-0.9).
EDs was suggested to be a predictor of PPC, with the optimal cut-off value being a drop in ΔSpO2 greater than -1.8% within 1 min of the start of the 6MWT.
The 6MWT, requiring no specialized equipment or expertise, can be conducted at various facilities and is suitable for diverse patient groups. While the 6-min walk distance is typically measured, concurrently evaluating EDs enhances the prediction of PPC. This will facilitate the identification of cases requiring perioperative respiratory rehabilitation intervention by a physical therapist as a strategy to minimize the impact or reduce the incidence of PPC.
postoperative pulmonary complication
early exercise-induced oxygen desaturation
