Impact of preserved ratio impaired spirometry on the Incidence of pulmonary complications and the Length of hospital stay following thoracoscopic lung cancer surgery

Background: Preserved Ratio Impaired Spirometry (PRISm) has been proposed to identify those with normal ratio but abnormal spirometry. This study investigated the relationship between PRISm and outcomes in patients who underwent thoracoscopic surgery for lung cancer. Methods: A retrospective cohort study of patients who underwent thoracoscopic surgery was conducted between December 2019 and December 2021 at Ningbo First Hospital. We used univariate and multivariate analyses to assess the possible associations between postoperative outcomes and clinical variables, including PRISm. Results: In this study, 1116 patients who underwent thoracoscopic surgery for lung cancer were enrolled. The incidence of postoperative pulmonary complications (PPCs) in the PRISm group was higher than that in the Normal group (17.7% vs. 7.7%, P <0.001). Pneumonia was the most significant PPC in both of the groups, but the incidence of pneumonia was higher in the PRISm group than in the Normal group (10.9% vs 3.6%, P <0.001). In addition, the median length of stay (LOS) in the hospital was longer in the PRISm group than in the Normal group (median [interquartile ranges (IQR)], 9 [7-13] vs. 8 [7-10], P <0.001). Multivariate analysis indicated that PRISm was the independent risk factor associated with both PPCs (OR=2.095, 95% confidence intervals (CI): 1.263-3.480, P =0.004) and prolonged LOS (B=0.864, SE=0.200, 95% CI: 0.470-1.257, P <0.001). Conclusion: PRISm significantly heightened the likelihood of adverse outcomes among patients undergoing thoracoscopic surgery for lung cancer. Prior attention and appropriate interventions directed towards PRISm hold significant value in mitigating its negative impact on patient outcomes.