Predictors and outcomes of postoperative pulmonary complications following abdominal surgery in a South Indian population (original) (raw)

2017, Anesthesia: Essays and Researches

The outcomes after abdominal surgery are influenced by postoperative complications, and pulmonary complications are associated with increased morbidity and length of hospital stay. [1] While cardiac complications are related directly to cardiac status, [2] postoperative pulmonary complications (PPC) combine infectious causes such as pneumonia, respiratory failure as well as exacerbation of chronic obstructive pulmonary disease (COPD). To assist with resource allocation, efforts have been made to identify risk factors for PPC in an effort to direct efforts toward patients identified to be at high risk. [3,4] The lack of specificity for respiratory symptoms makes it more difficult to individually evaluate PPC although unequivocal evidences are pneumonic changes on chest X-ray or positive sputum microbiology for pulmonary infections. Patients with COPD are at greater risk for the development of PPC. [5] Preoperative risk factors are a major determinant of postoperative morbidity. Several risk factors both preoperatively and intraoperatively have been identified with respiratory impairment after abdominal surgery. Conventionally, factors associated with PPC are chronic airway disease, advanced age, upper abdominal surgery, intraperitoneal sepsis, and obesity. Other factors affecting 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.