Obesity, pulmonary function may identify need for home oxygen after lung cancer surgery

Obesity and diffusing capacity of the lungs for carbon monoxide were significant risk factors for home oxygen use after pulmonary resection surgery, according to data published in Annals of the American Thoracic Society.

“Domiciliary oxygen use or being discharged with home oxygen after lung cancer surgery has been recently addressed by retrospective reviews of large databases, which showed for the first time that 15% of surgical patients continue to use oxygen at home for at least 1 month after discharge,” Daniel G. Nicastri, MD, assistant professor in the department of thoracic surgery at the Icahn School of Medicine at Mount Sinai, New York, and colleagues wrote. “Home oxygen use was associated with decreased survival.”

Researchers evaluated a prospective cohort of 433 patients (mean age, 69 years; 58.7% women) diagnosed with pathologic stage 1 non-small cell lung cancer who underwent surgery at Mount Sinai from 2016 to 2020. Researchers assessed risk factors associated with postoperative oxygen use and postsurgical morbidity in patients who underwent curative lung cancer surgery.

More than 14% of patients were discharged on home oxygen. Of these patients, 58% discontinued home oxygen within 1 month after discharge, while 17.5% discontinued use within 1 to 6 months after discharge.

In addition, length of stay was longer for patients who required home oxygen upon discharge compared with those who did not. Risk for home oxygen use was significantly higher among patients with a length of stay of 6 days (unadjusted OR = 3.4; 95% CI, 1.3-9.1; P = .01) and 5 days (unadjusted OR = 3.7; 95% CI, 1.2-11.1; P = .003) compared with those whose stay was 0 to 2 days.

BMI of 25 kg/m² to 30 kg/m² (OR = 4; 95% CI, 1.6-11.2) and 30 kg/m² or more (OR = 6.1; 95% CI, 2.4-17.5) and a preoperative diffusing capacity of the lungs for carbon monoxide (DLCO) of less than 40% (OR = 24.9; 95% CI, 3.6-234.1) and 40% to 59% (OR = 3.1; 95% CI, 1.3-7.2) were significant independent risk factors for risk for home oxygen after adjusting for other covariates. Other risk factors included female sex and pulmonary comorbidities.

“Our investigation identifies statistically significant risk factors for patients who require home oxygen after pulmonary resection surgery, allowing for better counseling of patients preoperatively,” the researchers wrote. “Overall, the data presented are also clinically significant, as they allow providers to thoroughly counsel patients on risk factors for home oxygen use after curative lung resection surgery.”