A retrospective cohort study of operated older patients undergoing lung resection after PFT-based versus CPET-based preoperative stratification

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Abstract
Background: A significant number of patients are unable to undergo surgery due to poor pulmonary function. In order to verify that this group of patients can be operated safely after a cardiopulmonary exercise test (CPET) and thus increase the number of operated patients, we conducted this trial. Methods: This was a retrospective study. From 2022 to 2024, we conducted preoperative evaluations on a cohort of hospitalized patients. These patients initially underwent a pulmonary function test (PFT) to assess surgical risk. Those with suboptimal PFT results underwent further CPET. Ultimately, 130 patients proceeded to surgical treatment. The primary outcome focused on the incidence of postoperative complications. Secondary endpoints included operative duration, intraoperative bleeding, postoperative hospital stay, etc. Results: This study included a total of 130 older patients, with 71 patients in the PFT group and 59 in the CPET group. Regarding postoperative complications, there was no statistically significant difference between the PFT group (n=17, 23.94%) and the CPET group (n=15, 25.42%) (P=0.76). Length of hospitalization (P=0.04) and chest tube duration (P=0.045) showed significant differences. No significant differences were observed in other perioperative outcomes either. Conclusions: For patients with suboptimal PFT results, further CPET is recommended. Compared to patients who underwent PFT alone, no significant differences were observed in postoperative complications. This suggests that CPET serves as a feasible supplementary tool that does not result in a statistically significant increase in postoperative complications in selected patients who proceed to surgery.

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