PURPOSE: Pulmonary complications are as common as cardiac complications in noncardiothoracic surgeries. Arterial blood gas analysis and pulmonary function testing have been advocated to identify pulmonary gas exchange problems in cirrhotics because clinical signs may not be present. The aim of our study was to asses if preoperative pulmonary function testing predicted postoperative morbidity and mortality in liver transplant surgery.
METHODS: A retrospective chart review of 123 liver transplant records was done at a large university tertiary care hospital and liver transplant center. Independent variables included age, gender, underlying liver disease, history of lung disease, smoking history, blood urea nitrogen, and various pulmonary functions [TLC, FVC, FEV1, FEV1/FVC, FEV25-75, FRC and DLCO]. The dependent variables were hospital stay, ICU stay, atelectasis, pneumonia, re-intubation, and mortality.
RESULTS: Of the 123 patients, 10.6% developed pneumonia, 27.6% had postoperative atelectasis, 17.1% had respiratory failure, while 23.6% (29/123) required mechanical ventilation more than 1 day postoperatively. A total of seven patients died before one year, four within 30 days of the transplantation. There was not an increased risk of atelectasis based on TLC (p=0.8), DLCO (p=0.61), FRC (p=0.96) or any other pulmonary functions. Also, the rate of respiratory failure and length of stay in the hospital or ICU were not associated with any pulmonary function.
CONCLUSIONS: There was no significant correlation between preoperative pulmonary function tests and postoperative pulmonary complications.
CLINICAL IMPLICATIONS: Although a negative study, our data reaffirms the lack of utility for preoperative pulmonary function tests in an unselected patient population. It may be more cost effective to obtain PFT’s only in high risk patients to better assess their pulmonary dysfunction.
DISCLOSURE: The following authors have nothing to disclose: Zeeshan Khan, Marc Lavietes, Ami Abraham, Geena Varghese, Rene Paulin, Baburao Koneru
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