Predictive capacity of risk indices in pulmonary resections

ABSTRACT

Pulmonary and cardiac complications are known to be the most frequent causes of morbidity and mortality after thoracic surgery. We attempted to correlate the relationship between the complications with preoperatively cardiac, pulmonary and cardiopulmonary risk indices in patients undergoing pulmonary resections. Complicatiosn in 15 consecutive patients with high cardiac (GoldmanÝs index); pulmonary (TorringtonÝs index) or cardiopulmonary (exercise capacity less than 3 METS) risk indices were compared with 31 consecutive patients without that risk factores. Nineteen complications developed in 15 patients in the high risk group and 4 complications occurred in 31 patients in the low risk group (p<0.0001). Death occurred in 8 patients in the high risk group, there were no deaths in the low risk group. Causes of death were Pneumonia 4; Contralateral bronchial obstruction 1; Cardiac death 1; Pulmonary Embolism 1 and Sepsis 1 patient. Patients assigned to Goldman cardiac index = 3 or 4; Torrington pulmonary index = 3 and maximal exercise capacity tower than 3 METS correlated well with high morbidity and mortality. Using together the three indices, sensitivity was similar but specificity was better all the patients who eventually died postoperatively had been preoperatively assigned to the high risk group. Our findings suggest that outcome and severity of complications after resective pulmonary surgery correlate with high risk cardiac, pulmonary and/or cardiopulmonary predictive indices.