Predicting the initiation for home oxygen therapy after lung resection using low-attenuation lung volume on computed tomography.

BACKGROUND: Home oxygen therapy (HOT) is used to treat chronic respiratory diseases and is sometimes required in patients after lung resection. It is important to evaluate the risk of the need for HOT after surgery. This study aimed to determine whether preoperative low-attenuation lung volume (LAV) on computed tomography (CT) could predict the need for HOT after lung resection. METHODS: We retrospectively reviewed patients who underwent lobectomy or segmentectomy from January 2019 to December 2020. Using their preoperative thin-slice contrast-enhanced CT images, we calculated the percentage of LAV-to-lung volume (LAV%). We then compared clinical factors, including LAV%, between patients who required HOT at discharge and those who did not. RESULTS: Of the 259 patients, 14 (5.4%) required HOT post-surgery. We found significant differences between the HOT and non-HOT groups in several factors, including sex, smoking index (pack-years), preoperative percent predicted forced expiratory volume in 1 second (%FEV1.0) and preoperative LAV%. Multivariate analysis identified preoperative LAV% [odds ratio (OR) 1.17, 95% confidence interval (CI): 1.07-1.31, P=0.001] and %FEV1.0 (OR 0.96, 95% CI: 0.93-1.00, P=0.04) as independent predictive factors for the initiation of HOT. Furthermore, a combined model incorporating LAV% and %FEV1.0 demonstrated potential predictive value, with an area under the curve (AUC) of 0.822. CONCLUSIONS: Preoperative LAV% is a significant and independent predictor of the initiation of HOT following lung resection. This finding suggests that quantitative CT analysis of emphysematous changes could help identify patients at high risk for postoperative oxygen support.