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

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.