title: Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients.
abstract: OBJECTIVE
  To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs).
  
  
  METHODS
  This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010.
  
  
  RESULTS
  Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs.
  
  
  CONCLUSIONS
  Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.
authors.affiliation: Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Physician. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Stanzani
authors.affiliation: Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil, Thoracic Surgeon. Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil.
authors.forename: Denise de Moraes
authors.initials: Dde M
authors.lastname: Paisani
authors.affiliation: Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Anderson de
authors.initials: Ad
authors.lastname: Oliveira
authors.affiliation: Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rodrigo Caetano de
authors.initials: RC
authors.lastname: Souza
authors.affiliation: Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Affiliate Professor. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: João Aléssio Juliano
authors.initials: JA
authors.lastname: Perfeito
authors.forename: Sonia Maria
authors.initials: SM
authors.lastname: Faresin
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D012129:Respiratory Function Tests; D012307:Risk Factors