(F)utility of preoperative pulmonary function testing in pectus excavatum to assess severity
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In brief
In brief
This study challenges the routine use of preoperative pulmonary function testing in pectus excavatum patients, finding a 48% non-completion rate with no correlation to disease severity. Analysis of 270 patients showed PFT completion status did not predict structural deformity or cardiopulmonary dysfunction.
- 48% of pectus excavatum patients failed to complete preoperative PFT, questioning its routine utility in surgical assessment.
- PFT completion status did not correlate with pectus severity indices, cardiac deformation, or patient symptoms.
- Inability to complete PFT should not be interpreted as a marker of more severe pectus excavatum deformity.
- Cardiac MRI and cardiopulmonary exercise testing may be more reliable than PFT for preoperative PE assessment.
- Routine preoperative PFT in pectus excavatum has limited clinical utility given high non-completion rates and lack of severity correlation.
Written by the GCMD Library team from the article.
Abstract
Purpose
The utility of pulmonary function testing (PFT) in pectus excavatum (PE) has been subject to debate. Although some evidence shows improvement from preoperative to postoperative values, the clinical significance is uncertain. A high failure-to-completion rate for operative PFT (48%) was identified in our large institutional cohort. With such a high non-completion rate, we questioned the overall utility of PFT in the preoperative assessment of PE and sought to evaluate if other measures of PE severity or cardiopulmonary function could explain this finding.
Methods
Demographics, clinical findings, and results from cardiac MRI, PFT (spirometry and plethysmography), and cardiopulmonary exercise tests (CPET) were reviewed in 270 patients with PE evaluated preoperatively between 2015 and 2018. Regression modeling was used to measure associations between PFT completion and cardiopulmonary function.
Results
There were no differences in demographics, symptoms, connective tissue disorders, or multiple indices of pectus severity and cardiac deformation in PFT completers versus non-completers. While regression analysis revealed higher RVEF, LVEF, and LVEF-Z scores, lower RV-ESV/BSA, LV-ESV/BSA, and LV-ESV/BSA-Z scores, and abnormal breathing reserve in PFT completers vs. non-completers, these findings were not consistent across continuous and binary analyses.
Conclusions
We found that PFT completers were not significantly different from non-completers in most structural and functional measures of pectus deformity and cardiopulmonary function. Inability to complete PFT is not an indicator of pectus severity.