Influence of reduced diffusing capacity and FEV₁ on outcome after cardiac surgery

Background: Impaired lung function is a well-known risk factor in cardiac surgery patients and reduced forced expiratory volume in 1 second (FEV₁ ) is associated with increased mortality. However, there is limited knowledge regarding the influence of impaired diffusing capacity of the lungs for carbon monoxide (DLCO) in unselected cardiac surgery patients. The aim of this study was to investigate the association of impaired DLCO and/or reduced FEV₁ on post-operative mortality and morbidity in cardiac surgery patients.

Methods: In a prospective cohort study, 390 patients scheduled for elective cardiac surgery underwent preoperative lung function test including spirometry and DLCO measurements. We defined reduced FEV₁ as FEV₁ below lower limit of normal (LLN) and impaired DLCO as DLCO <60% of predicted.

Results: Mortality within 1 year (90-570 days) was significantly higher in patients with impaired DLCO (12% vs 3%, P = .010) and with reduced FEV₁ (9% vs 3%, P = .028). Mortality was higher in patients with impaired DLCO both in the presence and absence of FEV₁ < LLN. In multivariate analysis, only impaired DLCO [OR: 3.3, 95% confidence interval (CI) 1.4-7.5; P = .005] and age (OR: 1.1 per year, 95% CI 1.0-1.2; P = .001) were independent predictors of the combined outcome of mortality and prolonged intensive care unit (ICU) stay. Impaired DLCO was also associated with post-operative respiratory complications.

Conclusion: In patients undergoing elective cardiac surgery, preoperative impaired FEV₁ and DLCO were associated with increased mortality and morbidity. In multivariate analysis, only DLCO and age were independent predictors of a combined outcome of mortality and prolonged ICU stay.