Study of post-operative pulmonary complications in patients of emergency abdominal surgeries (original) (raw)
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Patient Safety in Surgery, 2019
BackgroundPostoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit.MethodsFrom January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs.ResultsSixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48...
Risk factors for pulmonary complications after emergency abdominal surgery
Respiratory Medicine, 2007
Pulmonary complications are common after abdominal surgery. Although a variety of risk factors have been described for these complications, studies so far have focused on elective interventions. The aim of this study was to determine the incidence and predictors of pulmonary complications following emergency abdominal surgery.This was a prospective cohort study. Pre and intra-operative data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications (PPC) were analyzed.Two hundred and sixty-six consecutive adult patients were included and seventy-five (28.2%) developed PPC. Age >50 years (adjusted OR=3.86; P<0.001), body mass index (BMI) <21 kg/m2 or ⩾30 kg/m2 (adjusted OR=2.43; P=0.007) and upper or upper/lower abdominal incision (adjusted OR=2.57; P=0.027) were independently associated with PPC. Patients submitted to multiple procedures tended to be at a higher risk for PPC (adjusted OR=1.73; P=0.079). The development of PPC was associated with prolonged hospital stay (P<0.001) and increased death rate (P<0.001).Pulmonary complications are frequent among patients undergoing abdominal emergency surgery and lead to increased length of hospital stay and death rate. Older age, abnormal BMI, upper or upper/lower abdominal incision and multiple procedures are predictors of PPC in this setting.
Postoperative pulmonary complications following major elective abdominal surgery: a cohort study
Perioperative Medicine, 2016
BackgroundPostoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected patients undergoing major elective abdominal surgery was to determine the incidence and effects of PPC.MethodsData on all major elective abdominal operations performed over a 2-week period in December 2014 were collected in six hospitals. The primary outcome measure of PPC at 7 days was used. Univariate and multivariate analyses were performed to investigate how different factors were associated with PPC and the effects of such complications.ResultsTwo hundred sixty-eight major elective abdominal operations were performed, and the internal validation showed that the data set was 99 % accurate. Thirty-two (11.9 %) PPC were reported at 7 days. PPC was more common in patients with a history of chronic obstructive pulmonary disease compared to those with no history (26.7 vs....
European review for medical and pharmacological sciences, 2018
The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery. After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation. PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showe...
Anesthesia: Essays and Researches, 2017
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.
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.
Risk Factors for Postoperative Pulmonary Complications in Upper Abdominal Surgery
ANZ Journal of Surgery, 2007
Background: Post-operative pulmonary complications (PPCs) negatively affect patients' quality of life and can be life-threatening. Predictors of PPCs have been evaluated in patients who underwent various operations, but few studies have specifically focused on gastrectomy. Methods: We retrospectively studied 1,053 patients with gastric adenocarcinoma who underwent radical gastrectomy with lymphadenectomy in our hospital between 1999 and 2011. Post-operative pulmonary complications were defined as conditions such as pneumonia, macroscopic atelectasis, pneumothorax, and acute respiratory distress syndrome that developed within 30 d after surgery. We evaluated the relations between PPCs and pre-operative or intra-operative factors and assessed risk factors for PPCs after gastrectomy. Result: A total of 49 (4.7%) patients had PPCs. On univariate analysis, PPCs were significantly associated with male gender (p = 0.024), predicted vital capacity (VC) (p = 0.020), a lower pre-operative serum albumin concentration (p = 0.023), open surgery (p = 0.007), total gastrectomy (p < 0.001), combined resection of another organ (p = 0.001), extended operating time (p < 0.001), higher operative bleeding volume (p < 0.001), intra-operative or post-operative blood transfusion (p = 0.009), and pathologic tumor stage (p = 0.003). On multivariable analysis, extended operating time (odds ratio [OR], 3.21, 95% confidence interval [CI] 1.46-7.07; p = 0.004), total gastrectomy (OR, 2.65, 95% CI 1.25-5.59; p = 0.011) and predicted VC (OR, 2.42, 95% CI 1.01-5.85; p = 0.049) were independent risk factors. These three factors also were independent risk factors for post-operative pneumonia (total gastrectomy OR, 2.64, 95% CI 1.32-5.30; p = 0.006); extended operating time OR, 2.54, 95% CI 1.24-5.19; p = 0.011; and predicted VC OR, 2.41, 95% CI 1.01-5.75; p = 0.048). Conclusion: Extended operating time, total gastrectomy, and predicted VC were independent predictors of PPCs, particularly pneumonia, in patients with gastric cancer who underwent gastrectomy. In patients with restrictive pulmonary dysfunction who are scheduled to undergo total gastrectomy, reduced lymphadenectomy or the avoidance of combined resection should be considered to shorten the operating time.