Clinical nutrition ESPEN · 2026
Preoperative respiratory muscle strength, muscle mass, and respiratory sarcopenia as predictors of postoperative pulmonary complications after thoracic and cardiac surgery: A systematic review and meta-analysis.
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Mizusawa Hiroki, Toyama Shusuke, Okura Kazuki, Shiraishi Masashi, Noguchi Masaya, Kanki Kengo, Natsume Honoka, Higashimoto Yuji
Аннотация
BACKGROUND & AIMS: Postoperative pulmonary complications (PPCs) are common after thoracic, upper abdominal, and cardiac surgery and are associated with adverse outcomes. Respiratory sarcopenia (RS), characterized by coexisting reductions in respiratory muscle mass and strength, may represent a clinically relevant prognostic phenotype, but its prognostic value remains uncertain. This systematic review and meta-analysis aimed to assess whether low preoperative respiratory muscle mass, reduced strength, or their coexistence as RS or probable RS predicts PPCs after thoracic and cardiac surgery.
METHODS: We searched PubMed, Embase, Web of Science, and CENTRAL from January 1990 to February 2026 for studies relating preoperative respiratory muscle mass, strength or flow, or RS to PPCs. Risk of bias was assessed using the Quality In Prognosis Studies tool. Adjusted odds ratios (ORs) were pooled using random-effects models after harmonizing effect directions such that ORs >1 denoted higher risk.
RESULTS: Sixteen studies were included; all involved thoracic or cardiac surgery, and none included an upper abdominal cohort. Cutoff-based respiratory muscle strength or flow impairment was associated with increased odds of PPCs (OR 2.25, 95% confidence interval [CI] 1.50-3.37; I2 = 51.2%), with the most consistent association observed for percent-predicted peak expiratory flow (PEF) (OR 2.03, 95% CI 1.43-2.90; I2 = 0%). Continuous PEF was associated with PPCs, whereas ultrasound-based diaphragm indices showed smaller, non-significant associations. RS or probable RS was associated with PPCs (OR 2.08, 95% CI 1.33-3.26; I2 = 0%).
CONCLUSIONS: Preoperative functional respiratory muscle impairment, particularly reduced PEF, and RS or probable RS were associated with PPCs. Given that the evidence was limited, heterogeneous, and predominantly derived from thoracic surgery, prospective confirmation is needed.
METHODS: We searched PubMed, Embase, Web of Science, and CENTRAL from January 1990 to February 2026 for studies relating preoperative respiratory muscle mass, strength or flow, or RS to PPCs. Risk of bias was assessed using the Quality In Prognosis Studies tool. Adjusted odds ratios (ORs) were pooled using random-effects models after harmonizing effect directions such that ORs >1 denoted higher risk.
RESULTS: Sixteen studies were included; all involved thoracic or cardiac surgery, and none included an upper abdominal cohort. Cutoff-based respiratory muscle strength or flow impairment was associated with increased odds of PPCs (OR 2.25, 95% confidence interval [CI] 1.50-3.37; I2 = 51.2%), with the most consistent association observed for percent-predicted peak expiratory flow (PEF) (OR 2.03, 95% CI 1.43-2.90; I2 = 0%). Continuous PEF was associated with PPCs, whereas ultrasound-based diaphragm indices showed smaller, non-significant associations. RS or probable RS was associated with PPCs (OR 2.08, 95% CI 1.33-3.26; I2 = 0%).
CONCLUSIONS: Preoperative functional respiratory muscle impairment, particularly reduced PEF, and RS or probable RS were associated with PPCs. Given that the evidence was limited, heterogeneous, and predominantly derived from thoracic surgery, prospective confirmation is needed.