The role of cardiopulmonary exercise test used in preoperative evaluation in lung resections in prediction of postoperative complications

Objective: Preoperative evaluation is very important before lung resections. The role of using spirometric measurements is limited for predicting postoperative complications. Cardiopulmonary Exercise Testing (CPET) is an important step of preoperative evaluation. PeakVO2 which is parameter of CPET reflects aerobic capacity and it's low values are associated with post-op complications. İt has been reported in recent studies that VE/VCO2 is superior to peakVO2 in predicting post-op morbidity and it is an independent predictor of mortality. The aim of this study is determine whether patients are suitable for surgery with performing CPET in addition to spirometric studies used in pre-op pulmonary capacity evaluation of patients scheduled for lung resection and predict post-op complications. Method: 30 patients who diagnosed with lung cancer, infection, bronchiectasis and congenital lobar emphysema, with a mean age 57 (range 24-76 years) was included in this prospective observational study. Every patient was evaluated with respiratory function test and CPET. Post-op complications and discharge were followed up in patients who were taken to respiratory physiotherapy program after surgery. Results: 22 lobectomy, 5 bilobectomy and 3 pneumonectomy was performed. Post-op mortality didn't occur. Respiratory complications such as ventilatory failure, atelectasis, prolonged air leak and wound infection causing prolonged discharge time associated with morbidity. FEV1 wasn't correlated with CPET parameters P>0,05). There were no differences in pikVO2 levels in patients with complications. Patients with VE/VCO2 slope less than 35, complication didn't occur. Conclusion: According to logistic regression analysis, increases in age and VE/VCO2 slope increase post-op morbidity, but VE/VCO2 is an independent predictor of post-op morbidity. Key words: lung resection, risk stratification, VE/VCO2