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Eur J Cardiothorac Surg 2007;31:518-521. doi:10.1016/j.ejcts.2006.11.036
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection

^a Service of Thoracic Surgery, Salamanca University Hospital, 37007 Salamanca, Spain
^b Unit of Thoracic Surgery, "Umberto I°" Regional Hospital, Ancona, Italy
^c Division of Thoracic Surgery, National Cancer Institute, Naples, Italy

Received 26 September 2006; received in revised form 24 November 2006; accepted 27 November 2006.

^_* Corresponding author. Tel.: +34 923 291 383; fax: +34 923 291 383. (Email: gvs{at}usal.es).

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.

Key Words: Thoracic surgical procedures • Lung volume measurements • Postoperative care • Postoperative pain • Classification and regression trees

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