J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 3, March 2023, pages 127-132

A Trial of Adding Lung Protective Strategies to Existing Enhanced Recovery After Surgery Protocols and Its Effect on Improving Postoperative Lung Function

**Table 1.** Demographic and Clinical Characteristics of Subjects
Characteristic	Total (n = 99)	Control (n = 50)	ERAS (n = 49)	P value
ERAS: enhanced recovery after surgery; BMI: body mass index; IS: incentive spirometry.
Age	60.2 ± 13.6	59.2 ± 13.7	61.1 ± 13.5	0.50
< 30	3 (3.0)	2 (4.0)	1 (2.0)	0.90
30 - 50	18 (18.2)	9 (18.0)	9 (18.4)
50 - 70	54 (54.5)	28 (56.0)	26 (53.1)
70+	24 (24.2)	11 (22.0)	13 (26.5)
Race
White	82 (82.8)	42 (84.0)	40 (81.6)	0.53
Black	16 (16.2)	7 (14.0)	9 (18.4)
Other	1 (1.0)	1 (2.0)	0 (0.0)
Ethnicity
Hispanic	0 (0.0)	0 (0.0)	0 (0.0)
Non-Hispanic	99 (100.0)	50 (100.0)	49 (100.0)
BMI (kg/m²)	27.4 ± 7.1	27.2 ± 5.7	27.7 ± 8.4	0.71
Underweight (< 18.5)	5 (5.1)	2 (4.0)	3 (6.1)	0.95
Normal (≥ 18.5, < 25)	29 (29.3)	14 (28.0)	15 (30.6)
Overweight (≥ 25, < 30)	36 (36.4)	19 (38.0)	17 (34.7)
Obese (≥ 30)	29 (29.3)	15 (30.0)	14 (28.6)
Preoperative IS (average)	2,028.06 ± 766.8	2,043.3 ± 628.4	2,012.2 ± 895.2	0.84
Postoperative IS 30 min (average)	1,214.74 ± 801.4	1,195.2 ± 715.0	1,233.3 ± 894.1	0.88
Postoperative IS 1 h (average)	1,352.86 ± 821.8	1,313.9 ± 618.1	1,387.3 ± 975.3	0.72
Postoperative IS 2 h (average)	1,416.66 ± 788.1	1,376.3 ± 651.2	1,454.8 ± 906.4	0.70
Postoperative IS total (average)	1,323.76 ± 803.6	1,253.5 ± 593.7	1,390.4 ± 964.9	0.47
Percent decrease from preoperative
30 min	40.1%	41.5%	38.7%
1 h	33.3%	35.7%	31.1%
2 h	30.1%	32.6%	27.7%
Total (average)	34.7%	38.7%	30.9%
Change in IS (total-preoperative)	-789.98 ± 803.6	-829.90 ± 525.2	-752.20 ± 721.6	0.60
Preoperative O₂ saturation	97.90 ± 2.0	97.76 ± 2.3	98.04 ± 1.7	0.50
Postoperative O₂ saturation	97.68 ± 10.0	98.51 ± 1.4	96.83 ± 14.2	0.4
Average tidal volume	450.64 ± 68.4	460.50 ± 67.0	440.60 ± 69.1	0.15
Postoperative supplemental O₂
No	17 (17.2)	9 (18.0)	8 (16.3)	0.52
Yes	16 (16.2)	7 (14.0)	9 (18.4)
Unknown	1 (1.0)	1 (2.0)	- (0.0)
Missing	65 (65.7)	33 (66.0)	32 (65.3)

Table 1. Demographic and Clinical Characteristics of Subjects

Characteristic

Total (n = 99)

Control (n = 50)

ERAS (n = 49)

P value

N (%)

ERAS: enhanced recovery after surgery; BMI: body mass index; IS: incentive spirometry.

Age

60.2 ± 13.6

59.2 ± 13.7

61.1 ± 13.5

0.50

< 30

3 (3.0)

2 (4.0)

1 (2.0)

0.90

30 - 50

18 (18.2)

9 (18.0)

9 (18.4)

50 - 70

54 (54.5)

28 (56.0)

26 (53.1)

70+

24 (24.2)

11 (22.0)

13 (26.5)

Race

White

82 (82.8)

42 (84.0)

40 (81.6)

0.53

Black

16 (16.2)

7 (14.0)

9 (18.4)

Other

1 (1.0)

1 (2.0)

0 (0.0)

Ethnicity

Hispanic

0 (0.0)

Non-Hispanic

99 (100.0)

50 (100.0)

49 (100.0)

BMI (kg/m²)

27.4 ± 7.1

27.2 ± 5.7

27.7 ± 8.4

0.71

Underweight (< 18.5)

5 (5.1)

2 (4.0)

3 (6.1)

0.95

Normal (≥ 18.5, < 25)

29 (29.3)

14 (28.0)

15 (30.6)

Overweight (≥ 25, < 30)

36 (36.4)

19 (38.0)

17 (34.7)

Obese (≥ 30)

29 (29.3)

15 (30.0)

14 (28.6)

Preoperative IS (average)

2,028.06 ± 766.8

2,043.3 ± 628.4

2,012.2 ± 895.2

0.84

Postoperative IS 30 min (average)

1,214.74 ± 801.4

1,195.2 ± 715.0

1,233.3 ± 894.1

0.88

Postoperative IS 1 h (average)

1,352.86 ± 821.8

1,313.9 ± 618.1

1,387.3 ± 975.3

0.72

Postoperative IS 2 h (average)

1,416.66 ± 788.1

1,376.3 ± 651.2

1,454.8 ± 906.4

0.70

Postoperative IS total (average)

1,323.76 ± 803.6

1,253.5 ± 593.7

1,390.4 ± 964.9

0.47

Percent decrease from preoperative

30 min

40.1%

41.5%

38.7%

1 h

33.3%

35.7%

31.1%

2 h

30.1%

32.6%

27.7%

Total (average)

34.7%

38.7%

30.9%

Change in IS (total-preoperative)

-789.98 ± 803.6

-829.90 ± 525.2

-752.20 ± 721.6

0.60

Preoperative O₂ saturation

97.90 ± 2.0

97.76 ± 2.3

98.04 ± 1.7

0.50

Postoperative O₂ saturation

97.68 ± 10.0

98.51 ± 1.4

96.83 ± 14.2

0.4

Average tidal volume

450.64 ± 68.4

460.50 ± 67.0

440.60 ± 69.1

0.15

Postoperative supplemental O₂

17 (17.2)

9 (18.0)

8 (16.3)

0.52

Yes

16 (16.2)

7 (14.0)

9 (18.4)

Unknown

1 (1.0)

1 (2.0)

- (0.0)

Missing

65 (65.7)

33 (66.0)

32 (65.3)

**Table 2.** Modeling Association With Change in IS
Characteristic	Univariate association	Adjusted	P value for adjusted
IS measurement for ERAS is adjusted for age, BMI and preoperative O₂ saturation. ERAS: enhanced recovery after surgery; BMI: body mass index; IS: incentive spirometry.
Group
ERAS	77.7	(-211.2 - 366.6)	0.60	79.1	(-220.2 - 378.5)	0.60
No ERAS	Referent	Referent
Age
< 50	Referent	Referent
50 - 70	57.8	(-286.6 - 402.3)	0.75	74.6	(-278.6 - 427.9)	0.68
70+	-103.8	(-522.0 - 314.4)	0.63	-119.4	(-552.7 - 314.0)	0.59
BMI (kg/m²)
Underweight (< 18.5)	372.5	(-400.2 - 1,145.1)	0.35	385.8	(-408.4 - 1,180.0)	0.34
Normal (≥ 18.5, < 25)	Referent		Referent
Overweight (≥ 25, < 30)	88.3	(-274.5 - 451.0)	0.46	91.3	(-284.9 - 467.6)	0.63
Obese (≥ 30)	-61.0	(-446.6 - 324.5)	0.27	-93.8	(-492.4 - 304.7)	0.65
Preoperative O₂ saturation	2.7	(-68.5 - 73.9)	0.94	11.7	(-62.9 - 86.3)	0.76

Table 2. Modeling Association With Change in IS

Characteristic

Univariate association

Adjusted

P value for adjusted

IS measurement for ERAS is adjusted for age, BMI and preoperative O₂ saturation. ERAS: enhanced recovery after surgery; BMI: body mass index; IS: incentive spirometry.

Group

ERAS

77.7

(-211.2 - 366.6)

0.60

79.1

(-220.2 - 378.5)

0.60

No ERAS

Referent

Age

< 50

Referent

50 - 70

57.8

(-286.6 - 402.3)

0.75

74.6

(-278.6 - 427.9)

0.68

70+

-103.8

(-522.0 - 314.4)

0.63

-119.4

(-552.7 - 314.0)

0.59

BMI (kg/m²)

Underweight (< 18.5)

372.5

(-400.2 - 1,145.1)

0.35

385.8

(-408.4 - 1,180.0)

0.34

Normal (≥ 18.5, < 25)

Referent

Overweight (≥ 25, < 30)

88.3

(-274.5 - 451.0)

0.46

91.3

(-284.9 - 467.6)

0.63

Obese (≥ 30)

-61.0

(-446.6 - 324.5)

0.27

-93.8

(-492.4 - 304.7)

0.65

Preoperative O₂ saturation

2.7

(-68.5 - 73.9)

0.94

11.7

(-62.9 - 86.3)

0.76