Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry

Background Preserved ratio impaired spirometry (PRISm), defined as decreased FEV1 in the setting of normal ratio, is associated with an increased risk of respiratory disease and systemic comorbidities. Unlike severe obstructive pulmonary disease, little is known about the impact of preserved ratio impaired spirometry on short-term outcomes in patients undergoing laparoscopic gastrectomy and its association with small airway dysfunction (SAD). Methods This study enrolled 830 patients who underwent preoperative spirometry and laparoscopic gastrectomy between January 2021 and August 2023. Of these, 228 patients were excluded. Participants were categorized into three groups based on their baseline lung function, and postoperative outcomes were subsequently analyzed. Potential associations between postoperative outcomes and various clinical variables were examined using univariate and multivariate analyses. Results PRISm was identified in 16.6% of the patients, while SAD was present in 20.4%. The incidence of postoperative pulmonary complications (PPCs) was notably higher in the SAD group (20.3% vs. 9.8%, P=0.002) and the PRISm group (28.0% vs. 9.8%, P<0.001) compared with the normal group. Among the three groups, pneumonia was the most frequently observed PPC. Multivariate analysis revealed that both SAD (odds ratio [OR]=2.34, 95% confidence interval [CI]: 1.30-4.22, P=0.005) and PRISm (OR=3.26, 95% CI: 1.80-5.90, P<0.001) independently constituted significant risk factors associated with the occurrence of PPCs. Univariate analysis showed that female was a possible risk factor for PPCs in PRISm group. Conclusion Our study showed that PRISm and SAD were associated with the increased PPCs in patients undergoing laparoscopic gastrectomy for gastric cancer.