Role of spirometric and arterial gas data in predicting pulmonary complications after abdominal surgery (original) (raw)
Related papers
Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation
Acta bio-medica : Atenei Parmensis, 2006
Advanced age, smoking habit, obesity or malnutrition, the coexistence of hypercapnia, bronchospasm or bronchial hypersecretion, the lack of pre-operative preparation and/or a prolonged duration of anaesthesia can negatively influence respiratory function in patients undergoing abdominal or thoracic surgery. Spirometric testing of pulmonary function is recommended in patients with a history of tobacco use or dyspnoea who are considered for cardiac or upper abdominal surgery and for all patients who are candidated for lung resection. Spirometry can provide cut-off values of acceptable risk in patients that are candidated for abdominal and thoracic surgery. At-risk patients having resective lung surgery should undergo a split lung function study with quantitative lung scanning or computed tomography in order to estimate the function of residual parenchyma after surgery. In patients with borderline estimated values, a cardiopulmonary exercise test is useful to further stratify surgical ...
https://ijshr.com/IJSHR\_Vol.6\_Issue.3\_July2021/IJSHR-Abstract.041.html, 2021
Background: Spirometry is a universal, simple, and non-invasive pulmonary function test. Spirometry, along with calculation of the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), is helpful for diagnosing obstructive or restrictive lung disease. Postoperative Pulmonary Complications are defined as unintended pulmonary abnormalities that occur as a result of surgery which cause identifiable dysfunction. Purpose: To find the evidence showing the importance of pre-operative PFT to predict risk of pulmonary complications after abdominal surgery Methodology: The study was conducted according to Preferred Reporting Items for systematic reviews and meta-analysis guidelines. Evidences selected since year 2002- 2020 from PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), ResearchGate and ScienceDirect. Key words used were: Pulmonary Function Tests, Post-Operative Pulmonary Complications, and Abdominal Surgery. Analysis was done using 2 scales: Centre for Evidence-Based Medicine Levels of Evidence Scale. Total 12 articles were found. Among them 10 were selected. Results: 5 articles showed that preoperative PFT is important in prediction of PPCs while the other half concluded that routine preoperative spirometry is not necessary before non-thoracic surgeries. Conclusion: Based on evidences, in the nutshell it is reviewed that there is controversy regarding the value of preoperative pulmonary functions test in non-thoracic surgeries.
Value of preoperative spirometry to predict postoperative pulmonary complications
Respiratory Medicine, 1996
In order to determine the incidence of postoperative pulmonary complications (POPC) and the value of preoperative spirometry to predict pulmonary complications after upper abdominal surgery, 24 women and 36 men (total 60 patients) were studied prospectively (mean age 48.3 years). On the day before the operation and for 15 days after the operation, each patients's respiratory status was assessed by clinical examination, chest radiography, spirometry and blood gas analysis, and patients were monitored for pulmonary complications by a chest physician and a surgeon independently. In this study, postoperative pulmonary complications developed in 21 (35%) patients (pneumonia in 10 patients, bronchitis in nine patients, atelectasis in one patient, pulmonary embolism in one patient). Of 31 patients with abnormal preoperative spirometry, 14 (452%) patients showed complications, whereas among 29 patients with normal preoperative spirometry, 7 (24.1%) patients showed complications (PcO.05). The incidence of POPC was higher in patients with advanced age, smoking, preoperative abnormal findings obtained from physical examination of the chest, higher ASA class and longer duration of operation. The sensitivity (0.76) and specificity (0.79) of abnormal preoperative findings obtained from physical examination to predict POPC were higher than abnormal preoperative spirometry (0.67 and 0.56 retrospectively). There was no significant difference between patients with and without pulmonary complications in regard to weight, serum albumin, type of incision, incidence of abnormal preoperative blood gases and duration of postoperative hospital stay. We conclude that POPC is still a serious cause of postoperative morbidity. Multiple risk factors include preoperative abnormal spirometry responsible for development of POPC. If used alone, spirometry has limited clinical value as a screening test to predict POPC after upper abdominal surgery.
Australian Journal of Physiotherapy, 2009
Question: Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? Design: Prospective observational study. Participants: 268 consecutive patients undergoing elective upper abdominal surgery who received standardised pre-and postoperative prophylactic respiratory physiotherapy. Outcome measures: Predictors were 17 preoperative and intraoperative risk factors. A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present: radiological evidence of collapse/consolidation, temperature > 38°C, oxyhaemoglobin saturation < 90%, abnormal sputum production, sputum culture indicating infection, raised white cell count, abnormal auscultation findings, or physician's diagnosis of pulmonary complication. Results: 35 participants (13%) developed postoperative pulmonary complications. Five risk factors predicted postoperative pulmonary complications: duration of anaesthesia (OR 4.3, 95% CI 1.7 to 10.8); surgical category (OR 2.3, 95% CI 1.1 to 4.7); current smoking (OR 2.1, 95% CI 1.0 to 4.5); respiratory co-morbidity (OR 2.1, 95% CI 1.0 to 4.4); and predicted maximal oxygen uptake (OR 2.0, 95% CI 1.0 to 4.3). A clinical rule for predicting the development of postoperative pulmonary complications predicted 82% of participants who developed complications. The odds of high risk participants developing pulmonary complications were 8.4 (95% CI 3.3 to 21.3) times that of low risk participants. Conclusion: This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule. [Scholes RL, Browning L, Sztendur EM, Denehy L (2009) Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO 2 max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study.
Australian …, 2010
Question: Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? Design: Prospective observational study. Participants: 268 consecutive patients undergoing elective upper abdominal surgery who received standardised pre-and postoperative prophylactic respiratory physiotherapy. Outcome measures: Predictors were 17 preoperative and intraoperative risk factors. A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present: radiological evidence of collapse/consolidation, temperature > 38°C, oxyhaemoglobin saturation < 90%, abnormal sputum production, sputum culture indicating infection, raised white cell count, abnormal auscultation findings, or physician's diagnosis of pulmonary complication. Results: 35 participants (13%) developed postoperative pulmonary complications. Five risk factors predicted postoperative pulmonary complications: duration of anaesthesia (OR 4.3, 95% CI 1.7 to 10.8); surgical category (OR 2.3, 95% CI 1.1 to 4.7); current smoking (OR 2.1, 95% CI 1.0 to 4.5); respiratory co-morbidity (OR 2.1, 95% CI 1.0 to 4.4); and predicted maximal oxygen uptake (OR 2.0, 95% CI 1.0 to 4.3). A clinical rule for predicting the development of postoperative pulmonary complications predicted 82% of participants who developed complications. The odds of high risk participants developing pulmonary complications were 8.4 (95% CI 3.3 to 21.3) times that of low risk participants. Conclusion: This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule. [Scholes RL, Browning L, Sztendur EM, Denehy L (2009) Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO 2 max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study.
African Health Sciences
Background and Objectives: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. Methodology: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. Results: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). Conclusion: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.
Prospective External Validation of a Predictive Score for Postoperative Pulmonary Complications
Anesthesiology, 2014
Background: No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe). Methods: Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures o...
Turkish Journal of Anaesthesiology and Reanimation, 2019
Introduction Postoperative pulmonary complications (POPC) are related to various risk factors. POPC are an important cause of morbidity and mortality in the postoperative period (1, 2). The American Society of Anesthesiologists (ASA) scale is commonly used to subjectively estimate preoperative health status. Although originally created to collect statistical data and reporting in anaesthesia, it is now used to predict perioperative risk (3-5). With this scale, patients are divided according to how their underlying medical problems produce functional impediments to their daily activities (Table 1). Risks inherent to a specific procedure are not incorporated into the ASA classification. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index is another tool based on easily assessed seven factors. The index can be used to assess individual risk of POPC2 (Table 2). Methods Patient population We retrospectively reviewed medical records of patients who underwent upper and lower abdominal surgery (LAS) in our institution between January and June 2017. Upper abdominal surgeries included cholecystectomy, gastrec