Cardiopulmonary Testing Before Lung Resection: What Are Thoracic Surgeons Doing?

James M. Clark, Angelica S. Marrufo, Benjamin D. Kozower, Daniel J Tancredi, Miriam A Nuno, David T Cooke, Bradley H Pollock, Patrick S Romano, Lisa M Brown

Research output: Contribution to journalArticle

Abstract

Background: Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. Methods: An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines. Results: The response rate was 24.0% (n = 203). Most surgeons (n = 121, 59.6%) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40% for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3% versus 23.5% with 10-19 years of experience and 15.9% for 0-9 years of experience, P = .007). Overall, 52.2% refer patients with cardiovascular risk factors to cardiology and 42.9% refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6% versus 2.4%, P < .001). Only one respondent (0.5%) was 100% adherent to the ACCP guidelines, and 4.4% and 45.8% were 75% and 50% adherent, respectively. Conclusions: Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.

Original languageEnglish (US)
Pages (from-to)1006-1012
Number of pages7
JournalAnnals of Thoracic Surgery
Volume108
Issue number4
DOIs
StatePublished - Oct 1 2019

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Thorax
Lung
Guidelines
Cardiology
Physicians
Guideline Adherence
Lung Volume Measurements
Forced Expiratory Volume
Carbon Monoxide
Surgeons
General Practice
Thoracic Surgery
Databases
Morbidity
Mortality
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiopulmonary Testing Before Lung Resection : What Are Thoracic Surgeons Doing? / Clark, James M.; Marrufo, Angelica S.; Kozower, Benjamin D.; Tancredi, Daniel J; Nuno, Miriam A; Cooke, David T; Pollock, Bradley H; Romano, Patrick S; Brown, Lisa M.

In: Annals of Thoracic Surgery, Vol. 108, No. 4, 01.10.2019, p. 1006-1012.

Research output: Contribution to journalArticle

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abstract = "Background: Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. Methods: An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines. Results: The response rate was 24.0{\%} (n = 203). Most surgeons (n = 121, 59.6{\%}) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40{\%} for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3{\%} versus 23.5{\%} with 10-19 years of experience and 15.9{\%} for 0-9 years of experience, P = .007). Overall, 52.2{\%} refer patients with cardiovascular risk factors to cardiology and 42.9{\%} refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6{\%} versus 2.4{\%}, P < .001). Only one respondent (0.5{\%}) was 100{\%} adherent to the ACCP guidelines, and 4.4{\%} and 45.8{\%} were 75{\%} and 50{\%} adherent, respectively. Conclusions: Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.",
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AU - Clark, James M.

AU - Marrufo, Angelica S.

AU - Kozower, Benjamin D.

AU - Tancredi, Daniel J

AU - Nuno, Miriam A

AU - Cooke, David T

AU - Pollock, Bradley H

AU - Romano, Patrick S

AU - Brown, Lisa M

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