Preoperative Diaphragmatic Excursion and Postoperative Pulmonary Complications After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study.
- 1Department of Pulmonology, Faculty of Medicine, Selçuk University, 42250 Konya, Türkiye.
- 2Department of Surgery, Faculty of Medicine, Selçuk University, 42250 Konya, Türkiye.
Abstract
Background and Objectives: Postoperative pulmonary complications (PPCs) remain clinically relevant after bariatric surgery, while conventional risk assessment provides limited direct information on diaphragmatic performance. This study evaluated whether preoperative diaphragmatic excursion measured by ultrasonography was associated with European Perioperative Clinical Outcome (EPCO)-defined PPCs after laparoscopic sleeve gastrectomy (LSG) and whether it provided complementary discriminatory information beyond the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score. Materials and Methods: This retrospective observational cohort study included 128 adults who underwent primary elective LSG between May 2021 and March 2026. Preoperative bilateral diaphragmatic excursion was assessed by M-mode ultrasonography during quiet breathing and deep inspiration. The primary endpoint was occurrence of at least one EPCO-defined PPC during the index hospitalization. Associations were evaluated using parsimonious multivariable logistic regression, and discrimination was assessed using receiver operating characteristic analysis. Results: Seventy patients (54.7%) developed at least one PPC. Right deep inspiratory excursion showed the largest between-group difference (6.70 ± 0.4 cm in PPC-positive vs. 8.10 ± 0.6 cm in PPC-negative patients; p < 0.001). In the extended model, greater right deep inspiratory excursion was associated with lower odds of PPCs (adjusted OR per 1-cm increase 0.60, 95% CI 0.41-0.87; p = 0.007), while ARISCAT remained associated with PPC occurrence. ARISCAT alone yielded an area under the receiver operating characteristic curve (AUC) of 0.70 (95% CI 0.61-0.79), compared with 0.73 (95% CI 0.64-0.87) for right deep inspiratory excursion and 0.80 (95% CI 0.71-0.88) for the combined model. The combined model showed greater discrimination than ARISCAT alone (DeLong p = 0.03). In a sensitivity analysis excluding isolated minor atelectasis from the composite endpoint, the association remained directionally consistent but was no longer statistically significant (adjusted OR 0.75, 95% CI 0.48-1.02; p = 0.07). Conclusions: Lower preoperative diaphragmatic excursion was associated with EPCO-defined PPCs after LSG. Right deep inspiratory excursion may provide complementary physiological information to established clinical risk assessment, although prospective validation is required before routine clinical implementation.
Related
- Associations of Preoperative and Early Postoperative Biomarkers with Wound Complications in a Clinically Restricted Surgical Population: A Retrospective Cohort Study
- Preoperative nutritional status and its association with postoperative complications and survival in patients undergoing total hip arthroplasty: a retrospective cohort analysis
- Preoperative and early postoperative predictors of nausea and vomiting after laparoscopic abdominal surgery in an enhanced recovery programme
- Histopathological findings in laparoscopic sleeve gastrectomy specimens and their relation to preoperative endoscopy : A retrospective cross-sectional study of 954 patients
- Association between anesthetic fresh gas flow and postoperative inflammatory response in laparoscopic sleeve gastrectomy : A retrospective cohort study
BibTeX
@article{yormaz2026preoperative,
title = {{Preoperative Diaphragmatic Excursion and Postoperative Pulmonary Complications After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study.}},
author = {Burcu Yormaz and Serdar Yormaz},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62102008},
url = {https://europepmc.org/article/MED/42942539},
note = {CC BY},
}
RIS
TY - JOUR
TI - Preoperative Diaphragmatic Excursion and Postoperative Pulmonary Complications After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study.
AU - Burcu Yormaz
AU - Serdar Yormaz
PY - 2026
DA - 2026/10/17
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62102008
UR - https://europepmc.org/article/MED/42942539
AB - Background and Objectives: Postoperative pulmonary complications (PPCs) remain clinically relevant after bariatric surgery, while conventional risk assessment provides limited direct information on diaphragmatic performance. This study evaluated whether preoperative diaphragmatic excursion measured by ultrasonography was associated with European Perioperative Clinical Outcome (EPCO)-defined PPCs after laparoscopic sleeve gastrectomy (LSG) and whether it provided complementary discriminatory information beyond the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score. Materials and Methods: This retrospective observational cohort study included 128 adults who underwent primary elective LSG between May 2021 and March 2026. Preoperative bilateral diaphragmatic excursion was assessed by M-mode ultrasonography during quiet breathing and deep inspiration. The primary endpoint was occurrence of at least one EPCO-defined PPC during the index hospitalization. Associations were evaluated using parsimonious multivariable logistic regression, and discrimination was assessed using receiver operating characteristic analysis. Results: Seventy patients (54.7%) developed at least one PPC. Right deep inspiratory excursion showed the largest between-group difference (6.70 ± 0.4 cm in PPC-positive vs. 8.10 ± 0.6 cm in PPC-negative patients; p < 0.001). In the extended model, greater right deep inspiratory excursion was associated with lower odds of PPCs (adjusted OR per 1-cm increase 0.60, 95% CI 0.41-0.87; p = 0.007), while ARISCAT remained associated with PPC occurrence. ARISCAT alone yielded an area under the receiver operating characteristic curve (AUC) of 0.70 (95% CI 0.61-0.79), compared with 0.73 (95% CI 0.64-0.87) for right deep inspiratory excursion and 0.80 (95% CI 0.71-0.88) for the combined model. The combined model showed greater discrimination than ARISCAT alone (DeLong p = 0.03). In a sensitivity analysis excluding isolated minor atelectasis from the composite endpoint, the association remained directionally consistent but was no longer statistically significant (adjusted OR 0.75, 95% CI 0.48-1.02; p = 0.07). Conclusions: Lower preoperative diaphragmatic excursion was associated with EPCO-defined PPCs after LSG. Right deep inspiratory excursion may provide complementary physiological information to established clinical risk assessment, although prospective validation is required before routine clinical implementation.
SN - 1010-660X
SN - 1648-9144
ER -