Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery
Keywords:
abdominal surgery, risk factor, morbidityAbstract
OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient’s pulmonary status.
Downloads
References
Morton AP. Respiratory preparation for abdominal surgery. Med J Aust 1973;1:1300-4
Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth 1987; 59:1230-5.
Dureuil B, Cantineau JP, Vogel J, Desmonts JM. Vital capacity and diaphragmatic function after abdominal surgery. Anesthesiology 1984;61:A478.
Ford GT, Guenter CA. Toward prevention of postoperative pulmonary complications. Am Rev Respir Dis 1984;130:4-5.
Ford GT, Whitelaw WA, Rosenal TW, Cruse PJ, Guenter CA. Diaphragm function after upper abdominal surgery in humans. Am Rev Respir Dis 1983;7:431-6.
Ford GT, Rosenal TW, Clergue F, Whitelaw WA. Respiratory physiology in upper abdominal surgery. Clin Chest Med 1993;14:237-52.
Jackson CV. Preoperative pulmonary evaluation. Arch Intern Med 1988;148:2120-6.
Houston MC, Ratcliff DG, Hays JT, Gluck FW. Preoperative medical consultation and evaluation of surgical risk. South Med J 1987;80:1385-96.
Williams-Russo P, Charlson ME, Mackenzie R, Gold P. Predicting postoperative pulmonary complications. Arch Intern Med 1992;152:1209-13.
Hall JC, Tarala A, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 1991;99:923-7.
Mitchell C, Garrahy P, Peake P. Postoperative respiratory morbidity: identification and risk factors. Aust NZ J Surg 1992;52:203-9.
Torrington KG, Henderson CJ. Preoperative respiratory therapy. A program of preoperative risk assessment and individualized postoperative care. Chest 1988;93:946-51.
Celli BR. Preoperative respiratory care of the patient undergoing upper abdominal surgery. Clin Chest Med 1993;14:253-62.
Latimer RG, Dickman M, Day WC, Gunn ML, Schmidt CD. Ventilatory patterns and pulmonary complications after abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis. Am J Surg 1971;122:622-32.
American Thoracic Society Statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Respir Crit Care Med 1995;152(supp):77-120.
NHLBI. National asthma education program, expert panel report: Guidelines for diagnosis and management of asthma. J Allergy Clin Immunol 1991;88:425-534.
NHLBI. International consensus report on diagnosis and management of asthma. Bethesda, MD: National Institutes of Health publ; 1992:92-3091.
Frankel HM. Determination of body mass index. JAMA 1986;255:1292.
NHI. National institutes of health consensus development conference statement. Health implications of obesity. Ann Intern Med 1985;103:147-51.
American Thoracic Society. Lung function testing: selection of reference values and interpretational strategies. Am Rev Respir Dis 1991;144:1202-8.
Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130:12-15.
Murphy TF, Sethi S. Bacterial infection in chronic obstructive pulmonary disease: state of the art. Am Rev Respir Dis 1992;146:1067-83.
Sox HC. Probability theory in the use of diagnostic tests. An introduction to critical study of the literature. Ann Intern Med 1986;104:60-6.
Ransohoff DF, Feinstein AR. Problems spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978;26:926-9.
Concato J, Feinstein AR, Holford TR. The risk of determining risk with multivariable models. Ann Intern Med 1993;118:201-10.
Dureuil B, Vires N, Cantineau JP, Lecocguic J, Marty C, Aubier M, Desmonts JM. Mechanism of diaphragmatic dysfunction after abdominal surgery. Anesthesiology 1984;61:A479.
Collins CD, Darke CS, Knowelden J. Chest complications after upper abdominal surgery: their anticipation and prevention. Br Med J 1968;1:401-6.
Olsson GL. Bronchospasm during anaesthesia. A computer-aided incidence study of 136929 patients. Acta Anaesthesiol Scand
;31:244-52.
Martin LF, Asher EF, Casey JM, Fry DE. Postoperative pneumonia. Arch Surg 1984;119:379-83.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 1992;152:967-71.
Milledge JS, Nunn JF. Criteria of fitness for anaesthesia in patients with chronic obstructive lung disease. Br Med J 1975;3:670-3.
Tisi GM. Preoperative evaluation of pulmonary function. Am Rev Respir Dis 1979;119:293-310.
Lawrence VA, Page CP, Harris GD. Preoperative spirometry before abdominal operations: a critical appraisal of its predictive value. Arch Intern Med 1989;149:280-5.
Zibrak JD, ODonnell CR, Marton K. Indications for pulmonary function testing. Ann Intern Med 1990;112:763-71.
Hirshberg A, Adar R. Preoperative prediction of postoperative complications. Isr J Med Sci 1990;26:123-4.
