Valor dos achados clínicos e da avaliação funcional pulmonar pré-operatórios como preditores das complicações pulmonares pós-operatórias

Abstract

objectIve. To assess the relationship of clinical data and the results of preoperative pulmonary functional evaluation with postoperative pulmonary complications. Methods. We conducted a retrospective cohort study with patients who underwent pulmonary functional evaluation over a period of 5 years. We analyzed clinical, demographic and spirometric data, surgical procedures performed and postoperative pulmonary complications. results. We analyzed the medical records of 521 patients. Mean age was 59.5 ± 14 years, 65.8% were male, and 93.4% were white. Mean FEV1 was 76.6 ± 24.6% of predicted. There were clinical comorbidities in 73.5% of all cases (COPD in 29.8%). The most common surgical sites were thorax (n = 122; 23.4%) and upper abdomen (n = 117; 22.5%). Postoperative pulmonary complications occurred in 99 patients (19.0%), with respiratory failure being the most common (4.6%). Forty-three (8.3%) patients died. Rates of pulmonary complications were higher after thoracic (28.9%), cardiac (28%) and upper abdomen surgery (24.3%) (p≤0.0001). Most patients (66.7%) with pulmonary complications were classified as ASA III or IV (p<0.01), and in 70.2% of operations, time on anesthesia was > 3.5 hours (p≤0.0001). The difference in median length of hospital stay between patients with and without pulmonary complications was statistically significant (23.5 [15.8-34] days vs. 10 [6-18] days; p<0.001). Patients who had never smoked had fewer complications than those with current or past smoking history (p=0.04). We did not detect significant associations between postoperative pulmonary complications and presence of COPD, FEV1 or body mass index (p>0.05). conclusIon. The most important factors associated with postoperative pulmonary complications were surgical site, time of anesthesia, and ASA classification.

Incidência e fatores de complicações pulmonares pós-operatórias em pacientes submetidos à cirurgias de tórax e abdome

“…The ASA risk classification was also associated with the development of PPC. According to the study conducted by Silva et al 4 , ASA II patients have an increased risk of PPC. Surgical time is also important, and when greater than three hours, was associated with a higher occurrence of PPC.…”

“…PPC are more common in thoracic and abdominal surgeries, and the incidence was 18.2% in a study performed by a group from Porto Alegre (RS) 4 .…”

“…This factor was significantly associated with PPC in this study. However, when treated and controlled prior to the surgical procedure, COPD patients have the same incidence of PPCs as healthy subjects 4 , as is also expected to occur with diabetes.…”

“…We searched for pneumonia, tracheobronchitis, atelectasis, respiratory failure, prolonged tracheal intubation, bronchospasm, pulmonary embolism, pulmonary edema and pneumothorax or pleural effusion. The criteria used to determine the presence and classification of postoperative pulmonary complications were those established by Silva et al 4 . We tabulated the collected data in the Microsoft Office Excel® program and later analyzed them through descriptive and inferential statistics.…”

“…Postoperative pulmonary complications (PPC) include respiratory insufficiency, pneumonia, tracheal re-intubation within 48 hours or tracheal intubation for more than 48 hours due to the maintenance of mechanical ventilation due to acute respiratory failure, atelectasis, bronchospasm, exacerbation of chronic obstructive pulmonary disease (COPD), pneumothorax and pleural effusion³. PPCs are more common in thoracic and abdominal surgeries, with incidence varying from 12 to 70% 4 .…”