Clinical variables of preoperative risk in thoracic surgery
Palavras-chave:
Procedimentos cirúrgicos torácicos, Período pós-operatório, Complicações pós-operatória, Procedimentos cirúrgicos pulmonaresResumo
CONTEXTO: As complicações pulmonares pós-operatórias, principalmente a pneumonia e atelectasia, têm sido freqüentes causas de morbidade nas cirurgias torácicas. Há interesse em se identificar fatores no processo de avaliação pré-operatória que possam, isoladamente ou associados, contribuir para o aparecimento de tais complicações. OBJETIVO: Identificar as variáveis de risco para complicação pulmonar pós-operatórias na cirurgia torácica. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Hospital das Clínicas da Universidade Estadual de Campinas PARTICIPANTES: 145 pacientes adultos, ambos os sexos, internados para cirurgia torácica eletiva e classificados em baixo, moderado e alto risco para complicação pulmonar pós-operatória utilizando-se uma escala de avaliação de risco. PROCEDIMENTO: Os pacientes foram acompanhados até as 72 horas do pós-operatório e avaliados quanto ao aparecimento de complicações pulmonares pós-operatória, definidas com o aparecimento de atelectasia, pneumonia, traqueobronquite, chiado, intubação ou ventilação mecânica prolongada. VARIÁVEIS ESTUDADAS: A análise univariada foi aplicada no estudo das variáveis independentes idade, estado nutricional, doença respiratória, hábitos tabágicos, espirometria e tempo cirúrgico. A análise dos resultados através da regressão logística multivariada mostrou relação entre as variáveis dependentes e independentes. RESULTADOS: As complicações pulmonares pós-operatórias incidiram sobre 18.6% da amostra. Através da regressão logística multivariada, verificou-se que as variáveis que aumentaram as chances de complicações pulmonar pós-operatórias foram chiado (Odds ratio, OR = 6.2), estado nutricional (OR = 1.15), tabagismo (OR = 1.04) e duração da cirurgia (OR = 1.007). CONCLUSÃO: Chiado, estado nutricional, tabagismo e duração da cirurgia aumentaram a ocorrência de complicações pulmonares pós-operatórias em cirurgia torácica.
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Referências
Jackson CV. Preoperative pulmonary evaluation. Arch Intern Med 1988;148(10):2120-7.
Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg 1995;109:(2)275-81; discussion 281-3.
Liedman BL, Bennegãrd K, Olbe LC, Lundell LR. Predictors of postoperative morbidity and mortality after surgery for gastro- oesophageal carcinomas. Eur J Surg 1995;161(3):173-80.
Nierman E, Zakrzewski K. Recognition and management of preoperative risk. Rheum Dis Clin North Am 1999;25(3):585-622.
Wang J, Olak J, Ultmann RE, Ferguson MK. Assessment of pulmonary complications after lung resection. Ann Thorac Surg 1999;67(5):1444-7.
Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999;115(5 Suppl):58S-63S.
Tisi GM. Preoperative evaluation of pulmonary function. Va- lidity, indications, and benefits. Am Rev Respir Dis 1979;119(2):293-310.
Torrington KG, Henderson CJ. Perioperative respiratory therapy (PORT). A program of preoperative risk assessment and indi- vidualized postoperative care. Chest 1988;93(5):946-51.
Markos J, Mullan BP, Hillman DR, et al. Preoperative assess- ment as a predictor of mortality and morbidity after lung resec- tion. Am Rev Resp Dis 1989;139(4):902-10.
Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pul- monary complications after elective abdominal surgery. Chest 1996;110(3):744-50.
Roukema JA, Carol EJ, Prins JG. The prevention of pulmonary com- plications after upper abdominal surgery in patients with noncompromised pulmonary status. Arch Surg 1988;123(1):30-4.
Sabanathan S, Eng J, Mearns AJ. Alterations in respiratory me- chanics following thoracotomy. J R Coll Surg Edinb 1990;35(3):144-50.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 1992;152(5):967-71.
Olsson GL. Bronchospasm during anaesthesia. A computer- aided incidence study of 136,929 patients. Acta Anaesthesiol Scand 1987;31(3):244-52.
Latimer RG, Dickman M, Day WC, Gunn ML, Schmidt CD. Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postopera- tive computerized spirometry and blood gas analysis. Am J Surg 1971;122(5):622-32.
Lillington GA, Sachs DP. Preoperative smoking reduction: all or nothing at all? Chest 1998;113(4):856-8.
Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999;340(12):937-44.
Doyle RL. Assessing and modifying the risk of postoperative pulmonary complications. Chest 1999;115(5 Suppl):77S-81S.
Rochester DF, Esau SA. Malnutrition and the respiratory sys- tem. Chest 1984;85(3):411-5.
Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth 1987;59(10):1230-5.
Baier H, Somani P. Ventilatory drive in normal man during semistarvation. Chest 1984;85(2):222-5.
Williams-Russo P, Charlson ME, Mackenzie CR, Gold JP, Shires GT. Predicting postoperative pulmonary complications. Is it a real problem? Arch Intern Med 1992;152(6):1209-13.
Zibrak JD, O’Donnell CR. Indications for preoperative pul- monary function testing. Clin Chest Med 1993;14(2):227-36.
Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998;113(4):883-9.
Stéphan F, Boucheseiche S, Hollande J, et al. Pulmonary compli- cations following lung resection: a comprehensive analysis of in- cidence and possible risk factors. Chest 2000;118(5):1263-70.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck
S. Postoperative complications after thoracic and major abdomi- nal surgery in patients with and without obstructive lung dis- ease. Chest 1993;104(5):1445-51.
Epstein SK, Faling LJ, Daly BD, Celli BR. Predicting complications after pulmonary resection. Preoperative exercise testing vs. a multi- factorial cardiopulmonary risk index. Chest 1993;104(3):694-700.
Brooks-Brunn JA. Validation of a predictive model for postopera- tive pulmonary complications. Heart Lung 1998;27(3):151-8.
Ford GT, Guenter CA. Toward prevention of postoperative pul- monary complications. Am Rev Respir Dis 1984;130(1):4-5.
Lindberg P, Gunnarsson L, Tokics L, et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiol Scand 1992;36(6):546-53.
Ford GT, Rosenal TW, Clergue F, Whitelaw WA. Respiratory physiology in upper abdominal surgery. Clin Chest Med 1993;14(2):237-52.
Frankel HM. Determination of body mass index. JAMA 1986;255(10):1292.
Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Ann Intern Med 1985;103(1):147-51.
Must A, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr 1991;53(4):839-46. [pub- lished erratum in Am J Clin Nutr 1991;54(5):773].
Fleiss JL. Statistical methods for rates and proportions. 2nd Ed. New York: John Wiley & Sons Inc; 1981.
Hosmer DW, Lemershow S. Applied logistic regression. New York: John Wiley & Sons Inc; 1989.
Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. Pre- vention of postoperative pulmonary complications through res- piratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil 1998;79(1):5-9.
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