Predictors and Outcomes of Postoperative Pulmonary Complications following Abdominal Surgery in a South Indian Population

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Abstract

Background:

Postoperative pulmonary complications (PPC) following abdominal surgery are associated with increased morbidity and poorer outcomes. We prospectively examined risk factors associated with the development of PPC in patients undergoing abdominal surgery.

Aims:

The primary outcome was to determine the association of predefined risk factors in the prediction of PPC after abdominal surgery. Secondary outcomes were evaluation of outcomes of PPC.

Setting and Design:

This was a prospective study conducted in the gastrosurgical and urological units of a tertiary care referral hospital in patients undergoing abdominal surgery over a period of 6 months (November 2015–April 2016).

Materials and Methods:

Relevant preoperative and intraoperative variables were recorded by the anesthesiologist in a pro forma provided. Postoperatively, data from the Intensive Care Unit (ICU) were collected from data sheets. PPC were defined according to preset criteria and outcomes of the patients including ICU stay, hospital stay, and mortality were noted.

Statistical Analysis:

Chi-square test was used to find the association of risk factors of PPC. Mann–Whitney test was used for continuous variables and McNemar's test for postoperative respiratory variables. A final regression analysis was performed with factors with significant association ( P < 0.1)

Results:

One hundred and fifty patients were included, and 24 patients (16%) developed PPC as defined by our criteria. Emergency surgery (44.4% of PPC) and cardiac comorbidity (23.9% of PPC) were significant associations for pulmonary complications. The length of ICU and hospital stay (LOICU, LOHS) and mortality were higher in the group with pulmonary complications ( P < 0.001).

Conclusions:

Emergent surgery and cardiac comorbidities were independent predictors for the development of PPC. PPC are associated with increased LOHS, LOICU stay, and mortality.

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Most cited references 23

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Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

D Mannino, D. Thorn, A Swensen … (2008)

Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. The present study analysed data from 20,296 subjects aged > or =45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for. Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.

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Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.

John Cornell, , Gerald Smetana … (2006)

The importance of clinical risk factors for postoperative pulmonary complications and the value of preoperative testing to stratify risk are the subject of debate. To systematically review the literature on preoperative pulmonary risk stratification before noncardiothoracic surgery. MEDLINE search from 1 January 1980 through 30 June 2005 and hand search of the bibliographies of retrieved articles. English-language studies that reported the effect of patient- and procedure-related risk factors and laboratory predictors on postoperative pulmonary complication rates after noncardiothoracic surgery and that met predefined inclusion criteria. The authors used standardized abstraction instruments to extract data on study characteristics, hierarchy of research design, study quality, risk factors, and laboratory predictors. The authors determined random-effects pooled estimate odds ratios and, when appropriate, trim-and-fill estimates for patient- and procedure-related risk factors from studies that used multivariable analyses. They assigned summary strength of evidence scores for each factor. Good evidence supports patient-related risk factors for postoperative pulmonary complications, including advanced age, American Society of Anesthesiologists class 2 or higher, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure. Good evidence supports procedure-related risk factors for postoperative pulmonary complications, including aortic aneurysm repair, nonresective thoracic surgery, abdominal surgery, neurosurgery, emergency surgery, general anesthesia, head and neck surgery, vascular surgery, and prolonged surgery. Among laboratory predictors, good evidence exists only for serum albumin level less than 30 g/L. Insufficient evidence supports preoperative spirometry as a tool to stratify risk. For certain risk factors and laboratory predictors, the literature provides only unadjusted estimates of risk. Prescreening, variable selection algorithms, and publication bias limited reporting of risk factors among studies using multivariable analysis. Selected clinical and laboratory factors allow risk stratification for postoperative pulmonary complications after noncardiothoracic surgery.

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Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem.

D Spahn, L Magnusson, A Eichenberger … (2002)

Perturbation of respiratory mechanics produced by general anesthesia and surgery is more pronounced in morbidly obese (MO) patients. Because general anesthesia induces pulmonary atelectasis in nonobese patients, we hypothesized that atelectasis formation would be particularly significant in MO patients. We investigated the importance and resorption of atelectasis after general anesthesia in MO and nonobese patients. Twenty MO patients were anesthetized for laparoscopic gastroplasty and 10 nonobese patients for laparoscopic cholecystectomy. We assessed pulmonary atelectasis by computed tomography at three different periods: before the induction of general anesthesia, immediately after tracheal extubation, and 24 h later. Already before the induction of anesthesia, MO patients had more atelectasis, expressed in the percentage of the total lung area, than nonobese patients (2.1% versus 1.0%, respectively; P < 0.01). After tracheal extubation, atelectasis had increased in both groups but remained significantly more so in the MO group (7.6% for MO patients versus 2.8% for the nonobese; P < 0.05). Twenty-four hours later, the amount of atelectasis remained unchanged in the MO patients, but we observed a complete resorption in nonobese patients (9.7% versus 1.9%, respectively; P < 0.01). General anesthesia in MO patients generated much more atelectasis than in nonobese patients. Moreover, atelectasis remained unchanged for at least 24 h in MO patients, whereas atelectasis disappeared in the nonobese. We compared the resolution over time of pulmonary atelectasis after a laparoscopic procedure by performing computed tomography scans in two different groups of patients: 1 group had 10 nonobese patients, and in the other group there were 20 morbidly obese patients.

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Author and article information

Journal

Journal ID (nlm-ta): Anesth Essays Res

Journal ID (iso-abbrev): Anesth Essays Res

Journal ID (publisher-id): AER

Title: Anesthesia, Essays and Researches

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0259-1162

ISSN (Electronic): 2229-7685

Publication date (Print): Jan-Mar 2018

Volume: 12

Issue: 1

Pages: 199-205

Affiliations

[1]Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India

Author notes

Address for correspondence: Dr. Lakshmi Kumar, Department of Anaesthesiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India. E-mail: lakshmi.k.238@ 123456gmail.com

Article

Publisher ID: AER-12-199

DOI: 10.4103/aer.AER_69_17

PMC ID: 5872864

PubMed ID: 29628582

SO-VID: a2d265c7-5015-4b0f-bcf5-9491f649904a

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Predictors and Outcomes of Postoperative Pulmonary Complications following Abdominal Surgery in a South Indian Population

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Abstract

Background:

Aims:

Setting and Design:

Materials and Methods:

Statistical Analysis:

Results:

Conclusions:

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Most cited references 23

Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.

Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem.

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