Incidence and predictors of postoperative pulmonary complications after nonthoracic surgery in patients of 65 years old or more

Ryu, Yon Ju; Park, Ji Young; Baik, Su Jung; Lee, Jin Hwa; Cheon, Eun Mee; Chang, Jung Hyun

Abstract

BACKGROUND: As number of the older patients for general elective surgery is increasing, postoperative pulmonary complications in the elderly are common and are a significant source of morbidity and mortality.
METHODS
We retrospectively evaluated the incidence and predictors of postoperative pulmonary complications in 206 patients of 65 years old or more who underwent general elective nonthoracic surgery. Postoperative pulmonary complications were defined as newly developed atelectasis, pneumonia, pulmonary thromboembolism and acute respiratory failure requiring mechanical ventilation following surgery.
RESULTS
There were 28 (13.6%) postoperative pulmonary complications. Statistically significant predictors of pulmonary complications were as follows: underlying lung disease (odds ratio, 3.2; p<0.01), recent (within 2 weeks) upper respiratory tract infection (OR, 10.6; p<0.05), upper abdominal incision (OR, 4.9; p<0.001), duration of operation of 3 hours or more (OR, 2.9; p<0.05), a PaO2 of less than 75 mmHg (OR, 3.4; p<0.01), a alveolar-arterial oxygen difference [D(A-a)O2] of 30 mmHg or more (OR, 5.9; p<0.001), a serum albumin of 3.0 g/dL or less (OR, 4.9; p<0.001). Multiple logistic regression analyses revealed four preoperative clinical factors that are independently associated with pulmonary complications: a serum albumin of 3.0 g/dL or less (OR, 8.0; p<0.01), upper abdominal incision (OR, 5.7; p<0.01), a D(A-a)O2 of 30 mmHg or more (OR, 4.8; p<0.01), a forced expiratory volume in 1 second (FEV1) of less than 1.0L (OR, 7.2; p<0.01).
CONCLUSION
Preoperative spirometry, blood gas analysis and measurement of serum albumin can identify those patients with high risk for pulmonary complications after nonthoracic surgery among the aged.