Risk assessment for thoracotomy and lung resection

Respiratory vs Cardiac Risk
- Respiratory complications are the leading cause of morbidity/mortality, occur in up to 20% of cases
- Cardiac complications occur in 10-15% of cases
- Overall mortality rate is 3-4%

Risk Assessment Methods:

Predicted postoperative FEV1 (ppoFEV1) - Most important predictor
- over 40% = low risk
- under 30% = high risk, may need post-op ventilation
- Calculation: preop FEV1 × percentage of remaining lung

- Arterial blood gas: High risk if PaO2 under 60mmHg or PaCO2 over 45mmHg
- DLCO (diffusion capacity): High risk if under 40-50% predicted
- VO2max testing:
- over 20 mL O2/kg/min = low risk
- under 10-15 mL O2/kg/min = high risk
- Practical equivalent: 5 flights of stairs ≈ 20 mL O2/kg/min

Age Considerations:
- Elderly patients (80-92 years) have:
- Double the rate of pulmonary complications
- Triple the rate of cardiac complications

Clinical Applications:
- Results help determine surgical candidacy
- Guide post-op ventilation planning
- Low-risk patients should aim for early extubation
- May recommend against surgery for slow-growing tumors if mortality risk is too high

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