Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

Authors

  • Nertila Kodra University Hospital Center “Mother Teresa”, Tirana
  • Vjollca Shpata Faculty of Medical Technical Sciences, University of Medicine, Tirana
  • Ilir Ohri 1University Hospital Center “Mother Teresa”, Tirana; Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Medicine, Tirana

DOI:

https://doi.org/10.3889/oamjms.2016.059

Keywords:

postoperative, pulmonary, complications, risk factor, abdominal surgery

Abstract

BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.

AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.

MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.

RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95%CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95%CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01).

CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Rock P, Rich PB. Postoperative pulmonary complications. Curr Opin Anaesthesiol. 2003;16:123 31. http://dx.doi.org/10.1097/00001503-200304000-00004 PMid:17021450

McAlister FA, Bertsch K, Man J, Bradley J, and Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. The American Journal of Respiratory and Critical Care Medicine. 2005; 171(5):514–517. http://dx.doi.org/10.1164/rccm.200408-1069OC PMid:15563632

Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, and Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Critical Care Medicine. 2011;39(9):2163–2172. http://dx.doi.org/10.1097/CCM.0b013e31821f0522 PMid:21572323

Dimick JB, Chen SL, Taheri PA, et al. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004; 199:531–537. http://dx.doi.org/10.1016/j.jamcollsurg.2004.05.276 PMid:15454134

Qaseem A, Snow V, Fitterman N et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Annals of Internal Medicine. 2006;144 (8):575–580. http://dx.doi.org/10.7326/0003-4819-144-8-200604180-00008 PMid:16618955

Lawrence VA, Cornell JE, and Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Annals of Internal Medicine. 2006;144:596–608. http://dx.doi.org/10.7326/0003-4819-144-8-200604180-00011 PMid:16618957

Fischer SP, Bader AM, Sweitzer BJ. Preoperative evaluation. In Miller's Anaesthesia. 7th ed., Ch. 34. Churchill Livingstone. New York, 2010: p. 1019 22. http://dx.doi.org/10.1016/b978-0-443-06959-8.00034-0

Canet J, Gallart L, Gomar C et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–1350. http://dx.doi.org/10.1097/ALN.0b013e3181fc6e0a PMid:21045639

Arozullah AM, Khuri SF, Henderson WG, Daley J, for the Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Annals of Internal Medicine. 2001;135:847–857. http://dx.doi.org/10.7326/0003-4819-135-10-200111200-00005 PMid:11712875

Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Current Opinion in Anaesthesiology. 2013;26(2):107–115. http://dx.doi.org/10.1097/ACO.0b013e32835e8acd PMid:23407154

Smetana GW. Postoperative pulmonary complications: An update on risk assessment and reduction. Cleveland Clinic Journal Of Medicine. 2009;76, Supplement 4: S60-S65. http://dx.doi.org/10.3949/ccjm.76.s4.10 PMid:19880838

ASA Physical Status Classification System. American Society of Anesthesiologists. Available at https://www.asahq.org/For-Members/Clinical-Information/ASA-Physical-Status-Classification-System.aspx.

Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. In: Olmsted RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis. Mosby, 1996: pp. A–7.

Arozullah AM, Daley J, Henderson WG, Khuri SF, for the National Veterans Administration Surgical Quality Improvement Program. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg. 2000;232:242–253. http://dx.doi.org/10.1097/00000658-200008000-00015 PMid:10903604 PMCid:PMC1421137

Roizen MF, Fleisher LA. Anaesthetic implications of concurrent disease. In Miller's Anaesthesia.Ed. Miller R Ch. 35. 7th ed., Churchill Livingstone, New York, 2010: p. 1103 11.

Toori KU, Khan JS, Nomani AZ, Hussain SW, Hashmi S. A prospective study of factors predicting PPC in patients undergoing non cardiothoracic surgery under general anaesthesia in developing country. Anaesth Pain Intensive Care. 2012;16:252 6.

Mark A. Yoder, Sat Sharma, chief editor William A. Schwer, Medscape - Perioperative pulmonary management: e-medicine. Medscape.com/article 284983. [Last updated on 2013 Oct 2].

Smetna G. Preoperative pulmonary evaluation – Current concepts – A review article. N Engl J Med. 1999;340:937 44. http://dx.doi.org/10.1056/NEJM199903253401207 PMid:10089188

Rosa Maria Salani Motab, Carvalhedo de Bruin PF et al. Risk factors for pulmonary complications after emergency abdominal surgery. Respiratory Medicine. 2007;101:808-813. http://dx.doi.org/10.1016/j.rmed.2006.07.015 PMid:16963245

Sircar BN, Boston FK. Post-operative pulmonary complications. The British Medical Journal. 1940:82. http://dx.doi.org/10.1136/bmj.2.4150.82 PMid:20783206 PMCid:PMC2178986

Hall JC, Tarala RA, Hall JL. Respiratory insufficiency after abdominal surgery. Respirology. 1996;1:133–138. http://dx.doi.org/10.1111/j.1440-1843.1996.tb00022.x PMid:9434329

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205 13. http://dx.doi.org/10.1097/01.sla.0000133083.54934.ae PMid:15273542 PMCid:PMC1360123

Mitchell CK, Smoger SH, Pfeifer MP, Vogel RL, Pandit MK, Donnelly PJ, Garrison RN, Rothschild MA. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998;133:194–198. http://dx.doi.org/10.1001/archsurg.133.2.194 PMid:9484734

Published

2016-05-22

How to Cite

1.
Kodra N, Shpata V, Ohri I. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery. Open Access Maced J Med Sci [Internet]. 2016 May 22 [cited 2024 Mar. 29];4(2):259-63. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2016.059

Issue

Section

B - Clinical Sciences