Correlation between subclinical abnormalities of preoperative pulmonary function and recovery after laparoscopic hepatectomy: a retrospective cohort study

Q: What are the key findings of this study?

Preoperative isolated small airway dysfunction and preserved-ratio impaired spirometry were not associated with postoperative pulmonary complications.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Laparoscopic hepatectomy (n=771). Intervention: Isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) vs. Normal spirometry. Primary outcome: Postoperative pulmonary complications (PPCs) within 30 days (SAD vs. normal spirometry) (OR 1.345, 95% CI 0.935-1.935, p=0.111).

Q: What does this research mean for the field?

Preoperative isolated small airway dysfunction and preserved-ratio impaired spirometry are not independently associated with an increased risk of postoperative pulmonary complications following laparoscopic hepatectomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shuling Zhang; Xingyu Li; Weiping Ding; Hongyin Ma; Jing Yang; Jingjing Zhong

doi:10.21203/rs.3.rs-11008875/v1

November 6, 2026Open Access

Correlation between subclinical abnormalities of preoperative pulmonary function and recovery after laparoscopic hepatectomy: a retrospective cohort study

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Key result

Preoperative small airway dysfunction and PRISm are not associated with postoperative pulmonary complications.

OR 1.345
95% CI 0.935-1.935
P=0.111
n=771

Why the study?

The impact of preoperative isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) on postoperative pulmonary complications and outcomes following laparoscopic hepatectomy remained unclear.

Does preoperative isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) increase the risk of postoperative pulmonary complications and prolong length of stay in patients undergoing laparoscopic hepatectomy compared to normal spirometry?

Key Points

To evaluate the association between isolated small airway dysfunction or preserved-ratio impaired spirometry and postoperative pulmonary complications following laparoscopic hepatectomy.
Retrospective cohort study of 771 patients undergoing laparoscopic hepatectomy at a single center, categorized into normal spirometry (n = 439), small airway dysfunction (SAD, n = 172), and preserved-ratio impaired spirometry (PRISm, n = 160).
Multivariable regression analyses and 1:1 propensity score matching (163 pairs for normal vs. SAD; 101 pairs for normal vs. PRISm) were conducted to adjust for baseline confounders and compare short-term recovery outcomes.
Operative duration was identified on multivariable analysis as the sole independent risk factor for postoperative pulmonary complications (OR = 1.200, P < .001).
Following 1:1 propensity score matching, no significant differences were observed in postoperative pulmonary complications or other short-term outcomes between matched cohorts.

Study Design

Type

Cohort (n=771)

Multicenter

No

Structured PICO

Does preoperative isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) increase the risk of postoperative pulmonary complications and prolong length of stay in patients undergoing laparoscopic hepatectomy compared to normal spirometry?

P

Population

771 adults (mean age ~63 years, 54.6% female) undergoing laparoscopic hepatectomy with preserved FEV1/FVC ratio (>=0.70), evaluated over 30 days postoperatively.

E

Exposure

Preoperative subclinical pulmonary function abnormalities: isolated small airway dysfunction (SAD, n=172) or preserved-ratio impaired spirometry (PRISm, n=160) in patients undergoing standardized laparoscopic hepatectomy (CO2 insufflation pressure 12 mmHg, supine positioning, general anesthesia)

C

Comparator

Normal preoperative spirometry (n=439) in patients undergoing standardized laparoscopic hepatectomy; evaluated via multivariable analysis and 1:1 propensity score matching (163 matched pairs for Normal vs SAD; 101 matched pairs for Normal vs PRISm)

O

Outcome

Postoperative pulmonary complications (PPCs) within 30 days of surgery, defined as a composite of productive cough, pneumonia, atelectasis, pleural effusion, respiratory failure, and pulmonary embolismcomposite

Main Result

Odds Ratio: 1.345 (95% CI 0.935–1.935)

Absolute Event Rate: 45.3% vs 39%

p-value: p=0.111

Preoperative subclinical spirometric abnormalities (isolated small airway dysfunction and preserved-ratio impaired spirometry) are not independently associated with postoperative pulmonary complications or prolonged hospital stay after laparoscopic hepatectomy once adjusted for surgical complexity and baseline comorbidities.

Limitations

Single-center retrospective design subject to information bias from medical records
A considerable proportion of patients were excluded due to missing or invalid preoperative pulmonary function tests
Up to 37.9% of cases lacked clear anatomical surgical resection site documentation in records
Unmeasured intraoperative and perioperative confounders such as CO2 pressure, surgical positioning, anesthetic regimen, ventilatory strategy, and fluid balance were not analyzed
Single-center retrospective design limited by information bias from medical records
A considerable proportion of patients did not complete pulmonary function testing or had invalid results (312 excluded for missing/invalid data, 240 failed to meet requirements)
Up to 37.9% of cases lacked clear anatomical site documentation in surgical records, limiting extrapolation regarding the impact of resection location
Intraoperative factors (CO2 pressure, surgical position) and perioperative management (anesthetic regimen, ventilatory strategy, intraoperative fluid balance) were not analyzed and may serve as unmeasured confounding factors

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Implication

Preoperative SAD and PRISm do not predict PPCs; leaves open whether spirometry adds value beyond operative factors.

Abstract

Background The impact of isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) on outcomes following laparoscopic hepatectomy remains unclear. Aims This study aimed to evaluate their association with postoperative pulmonary complications (PPCs). Method This single-center retrospective study included 771 patients. Multivariable analyses and propensity score matching (PSM) were employed to compare outcomes between patients with normal spirometry and those with SAD or PRISm. Results The PRISm group was associated with higher ICU admission rates (12.5% vs 5.0%, P = .001) and longer length of stay (LOS) (15.0 vs 12.0 days; P < .001). However, multivariable analysis identified operative duration as the sole independent risk factor for PPCs (OR = 1.200, P < .001). After 1:1 PSM, the matched cohorts (163 pairs vs. SAD; 101 pairs vs. PRISm) showed no significant differences in PPCs or other short-term outcomes. Surgical complexity (duration, transfusion), comorbidities (diabetes, age) and the occurrence of PPCs were the independent factors for prolonged LOS. Conclusion Preoperative SAD and PRISm were not associated with an increased risk of PPCs after laparoscopic hepatectomy. Prolonged LOS was significantly associated with surgical complexity, patient comorbidities, and the development of PPCs, but not with baseline spirometric anomalies.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cohort in Laparoscopic hepatectomy (n=771). Isolated small airway dysfunction (SAD) or preserved-ratio impaired spirometry (PRISm) vs. Normal spirometry was evaluated on Postoperative pulmonary complications (PPCs) within 30 days (SAD vs. normal spirometry) (OR 1.345, 95% CI 0.935-1.935, p=0.111). Preoperative isolated small airway dysfunction and preserved-ratio impaired spirometry were not associated with postoperative pulmonary complications.

synapsesocial.com/papers/6aefbd6950d2071ffda4bd36 https://doi.org/10.21203/rs.3.rs-11008875/v1

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Correlation between subclinical abnormalities of preoperative pulmonary function and recovery after laparoscopic hepatectomy: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Correlation between subclinical abnormalities of preoperative pulmonary function and recovery after laparoscopic hepatectomy: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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