Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry

Jun Gong; Linbin Xu; Hang Yu; Feng Qiu; Zhiping Zhang; Yongfang Yin; Hongying Ma; Zejun Cai; Jingjing Zhong; Weiping Ding; Chao Cao

doi:10.1016/j.gassur.2024.03.022

Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry

J Gastrointest Surg. 2024 Mar 19:S1091-255X(24)00376-7. doi: 10.1016/j.gassur.2024.03.022. Online ahead of print.

Authors

Jun Gong¹, Linbin Xu¹, Hang Yu², Feng Qiu², Zhiping Zhang³, Yongfang Yin³, Hongying Ma², Zejun Cai³, Jingjing Zhong², Weiping Ding², Chao Cao⁴

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, China.
² Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China.
³ Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China.
⁴ Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China. Electronic address: fyycaochao@nbu.edu.cn.

PMID: 38513947
DOI: 10.1016/j.gassur.2024.03.022

Abstract

Background: Preserved ratio impaired spirometry (PRISm), defined as decreased forced expiratory volume in the first second in the setting of normal ratio, is associated with an increased risk of respiratory disease and systemic comorbidities. Unlike severe obstructive pulmonary disease, little is known about the impact of PRISm on short-term outcomes in patients undergoing laparoscopic gastrectomy (LG) and its association with small airway dysfunction (SAD).

Methods: This study enrolled 830 patients who underwent preoperative spirometry and LG between January 2021 and August 2023. Of these, 228 patients were excluded. Participants were categorized into 3 groups based on their baseline lung function, and postoperative outcomes were subsequently analyzed. Potential associations between postoperative outcomes and various clinical variables were examined using univariate and multivariate analyses.

Results: PRISm was identified in 16.6% of the patients, whereas SAD was present in 20.4%. The incidence of postoperative pulmonary complications (PPCs) was notably higher in the SAD group (20.3% vs 9.8%, P = .002) and the PRISm group (28.0% vs 9.8%, P < .001) than the normal group. Among the 3 groups, pneumonia was the most frequently observed PPC. Multivariate analysis revealed that both SAD (odds ratio [OR], 2.34; 95% CI, 1.30-4.22; P = .005) and PRISm (OR, 3.26; 95% CI, 1.80-5.90; P < .001) independently constituted significant risk factors associated with the occurrence of PPCs. Univariate analysis showed that female was a possible risk factor for PPCs in PRISm group.

Conclusion: Our study showed that PRISm and SAD were associated with the increased PPCs in patients undergoing LG for gastric cancer.

Keywords: Laparoscopic gastrectomy; Postoperative pulmonary complications; Preserved ratio impaired spirometry.