Preoperative quality of life predicts complications in thoracic surgery needs further evaluation

Dear Editor,

We read with great interest the article by Peters et al. [1], regarding the self-reported preoperative health-related quality of life (HRQOL) can predict incidence of postoperative complications among patients undergoing thoracic surgery. This study utilizes preoperative HRQOL as a novel indicator for predicting postoperative complications, providing a fresh perspective on assessing the preoperative risk of patients. This is meaningful in identifying high-risk patients and developing personalized preoperative management strategies in the clinic.

However, we noticed that there were certain obvious limitations in this article, which may reduce the reliability of this study. As a typical retrospective, single‐centre study, the authors did not fully account for surgical type differences. Patients undergoing more extensive resections often represent such thoracic diseases that have more impact on their daily life. Previous study revealed that poor preoperative quality of life increased the risk of postoperative adverse events, and finally cased prolonged hospital stay after lobectomy [2]. In the clinic, most patients are treated with sublobar resections because of pulmonary nodules found by routine physical examination without any complaint. Patients with larger pulmonary nodules, who have definite lobectomy indication, reported symptoms including cough and shortness of breath, which impact their quality of life. On the other hand, different surgical types are relevant to the postoperative outcome and complications. For instance, minimally invasive surgery can improve the quality of life of postoperative patients, while segmentectomy and lobectomy have different complication rates [3, 4]. Furthermore, 93 (18.1%) patients who suffered from stage IV cancer were included in the study. These patients may have worse preoperative quality of life and more extensive resections than others. We suggest it is necessary to perform the subgroup analysis by type of surgery, at least compare patients undergoing more extensive resections (i.e. Lobectomy or oesophagectomy) and patients undergoing less extensive procedures separately.

In addition, the study needs more detail evaluations about HRQOL. Although the study emphasized the importance of HRQOL, the specific impacts of various dimensions of HRQOL, including mobility, self-care ability and mood, have not been thoroughly examined. Preoperative state anxiety is a predictor of postoperative HRQOL immediately after surgery, which caused lower HRQOL in lung cancer patients [5]. The adequacy of detailed evaluations on HRQOL may overlook certain crucial factors contributing to postoperative complications. Moreover, the different anesthesia type can impact postoperative recovery and the incidence of complications, which were ignored in the study [6].

Finally, it was noted that the median age of the patients was 66.3 and the mean BMI (body mass index) was 28.9 in the study. That means more elderly and overweight patients involved in the study. We suggest that conducting subgroup analysis based on age and body mass index is imperative to avoid obvious limitations in the clinical application of the study’s conclusions.

In summary, this study reminds us to pay more focus on the preoperative quality of life of patients in thoracic surgery. We are convinced that a more rigorous further analysis can enhance the reliability of this study and definite the application scope of this research conclusion. This way, preoperative quality of life can predict complications in thoracic surgery more reliably.

FUNDING

This work was supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Project (Grant No. 2024ZF001) and Zhejiang Provincial Natural Science Foundation of China (Grant No. LBY24H170005).

Conflict of interest: none declared.

REFERENCES

Author notes