Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations

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5 Scopus citations

Abstract

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non–small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98–0.99]; P, 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98–0.98]; P, 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98–0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98–0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.

Original languageEnglish (US)
Pages (from-to)38-46
Number of pages9
JournalAnnals of the American Thoracic Society
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2024

Keywords

  • lobectomy
  • non–small cell lung cancer
  • pulmonary complications
  • pulmonary function testing
  • race-based interpretation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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