Tuberc Respir Dis.  2007 Jun;62(6):516-522.

A Prospective Study for Risk Factors Predicting Postoperative Pulmonary Complications

Affiliations
  • 1Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea. light@gilhospital.com

Abstract

Background
Postoperative pulmonary complications are important problems that prolong the length of the hospital stay and increase patient mortality. However, our knowledge of the postoperative factors that increase the risk of these complications is less than complete. Methods: We conducted a prospective study to determine the risk factors for postoperative pulmonary complications. A total of 199 patients were referred to the Pulmonology Department for preoperative pulmonary evaluation. We reviewed the perioperative variables according to the National Surgical Quality Improvement Program (NSQIP). Postoperatively, we collected data on the occurrence of postoperative pulmonary complications and we evaluated the relationship between the perioperative variables and outcomes. Results: Twenty two patients (11%) had pulmonary complications; 6 had respiratory failure, 4 had pneumonia, 13 had pleural effusion and, 2 had atelectasis. Five variables were statistically significantly associated with pulmonary complications on the bivariate analyses. Multiple logistic regression analyses revealed that three of these variables were independently associated with an increased risk of pulmonary complications; a high cardiac risk index (OR 16.5, p=0.002), emergency surgery (OR 10.3, p=0.017), and thoracic/abdominal surgery (OR 3.8, p=0.047). Conclusion: The risk factors for postoperative pulmonary complications are a high cardiac risk index, emergency surgery and thoracic/abdominal surgery.

Keyword

Postoperative; Pulmonary Complications; Risk factors

MeSH Terms

Emergencies
Humans
Length of Stay
Logistic Models
Mortality
Pleural Effusion
Pneumonia
Prospective Studies*
Pulmonary Atelectasis
Pulmonary Medicine
Quality Improvement
Respiratory Insufficiency
Risk Factors*

Reference

1. Wiener-Kronish JP, Albert RK. Mason R J, Broaddus VC, Murray JF, Nadel JA, editors. Chapter 26. Preoperative evaluation. Murray and Nadel's Textbook of Respiratory Medicine. 2005. 4th ed. Philadelphia: Elsevier Inc.;781–794.
2. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med. 1999. 340:937–944.
3. Epstein SK, Faling LJ, Daly BD, Celli BR. Predicting complications after pulmonary resection: preoperative exercise testing vs a multifactorial cardiopulmonary risk index. Chest. 1993. 104:694–700.
4. Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Admistration Surgical Quality Improvement Program. Ann Surg. 2000. 232:242–253.
5. Arozullah AM, Khuri SF, Henderson WG, Daley J. 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. Ann Intern Med. 2001. 135:847–857.
6. McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005. 171:514–517.
7. Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest. 1996. 110:744–750.
8. Kim JH, Kim MH, Kim DS. A prospective controlled study about the effect of incentive spirometer on the postoperative pulmonary complications. Korean J Intern Med. 1986. 31:27–37.
9. Kim MK, Kwon J, Lee CT, Cho SH, Han SG, Shim YS, et al. Clinical significance of FEV1.0 to predict postoperative pulmonary complications. Tuberc Respir Dis. 1989. 36:333–340.
10. Park JW, Jeong SW, Nam GH, Suh GY, Kim HC, Chung MP, et al. Preoperative evaluation for the prediction of postoperative mortality and morbidity in lung cancer candidates with impaired lung function. Tuberc Respir Dis. 2000. 48:14–23.
11. Ryu YJ, Park JY, Baik SJ, Lee JH, Cheon EM, Chang JH. Incidence and predictions of postoperative pulmonary complications after nonthoracic surgery in patients of 65 years old or more. Korean J Med. 2004. 67:65–72.
12. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Circulation. 2002. 105:1257–1267.
13. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in nonthoracic surgical procedures. N Engl J Med. 1977. 297:845–850.
14. Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med. 1990. 88:101–107.
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