A prospective survey of the incidence of postoperative pulmonary complications

Wightman, J. A.

doi:10.1002/bjs.1800550202

Cited by 263 publications

(70 citation statements)

References 19 publications

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“…radiographic evidence of atelectasis, with or without pleural fluid. With this broader definition of complication, the incidence of postoperative complications of UAS is approximately 25-75% [9,10].In this paper, we examine the relationship between preoperative respiratory symptoms and physiology, and postoperative risk of severe respiratory complications (SRCs) in patients undergoing UAS. In particular, we will address the question: "Is there a functional best test to predict the postoperative morbidity and mortality in the high-risk pulmonary patient group?…”

mentioning

confidence: 99%

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Barisione¹,

Rovida²,

Gazzaniga³

et al. 1997

Eur Respir J

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We evaluated the capacity to predict severe respiratory complications (SRCs) following upper abdominal surgery (UAS) by using the results of a respiratory questionnaire and preoperative pulmonary function tests.Lung volumes, flows and transfer factor of the lung for carbon monoxide (TL,CO,sb) were assessed in 361 consecutive adult patients (248 males and 113 females). SRCs were diagnosed 24 h after UAS by clinical examination and chest radiography. Univariate and stepwise multiple logistic regression analyses were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each single input variable, and to determine which indices best predicted outcome.These patients had a 1% mortality rate and 14% incidence of SRCs, with a male:female ratio of 0.86. The best predictors for SRCs by multiple analysis were: preoperative current hypersecretion of mucus (OR=133; p<0.0001); an increase in residual volume (RV) (OR=3.11; p=0.01); and, to a lesser extent, low percentage of predicted values both of forced expiratory volume in one second (FEV1 % pred) and TL,CO,sb. The algorithm thus obtained (logit θ) was extremely sensitive (84%), specific (99%), and accurate (95%) for preoperative prediction of SRCs.We have found that preoperative current hypersecretion of mucus and pulmonary hyperinflation, and to a lesser extent percentage predicted values both of forced expiratory volume in one second and transfer factor of the lung for carbon monoxide, have a significant predictive capacity for severe respiratory complications following upper abdominal surgery. Eur Respir J 1997; 10: 1301-1308 Since 1910, it has been well-known that patients undergoing upper abdominal surgery (UAS) generally develop a severe pulmonary restrictive pattern [1], and carry a high risk of postoperative respiratory complications [2][3][4]. The most important factors determining the degree of postoperative impairment of ventilation and gas exchange are the site of operation, the age, and clinical status of the patient [5]. Forced vital capacity (FVC) and peak flows are often reduced to half, and the functional residual capacity (FRC) to below 70% of the preoperative values [5]. These effects may not be restored even by the fifth postoperative day [5]. The reduced FVC and the reduction of FRC are mainly a consequence of an impaired diaphragmatic function [6]. Furthermore, the risk for postoperative respiratory complications decreases with the distance of the surgical incision from the diaphragm [7,8].Several studies have tried to determine the incidence of postoperative respiratory complications of UAS, and the estimates vary widely. The majority of investigations have focused on subclinical complications, i.e. radiographic evidence of atelectasis, with or without pleural fluid. With this broader definition of complication, the incidence of postoperative complications of UAS is approximately 25-75% [9,10].In this paper, we examine the relationship between preoperative respiratory symptoms and physiology, and postoperative r...

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mentioning

confidence: 99%

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Barisione¹,

Rovida²,

Gazzaniga³

et al. 1997

Eur Respir J

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“…Smoking cessation of at least 4 weeks before surgery reduces the risk of postoperative complications, and longer periods of smoking cessation may be even more effective. 18 In a 2014 meta-analysis, preoperative smoking was associated with an increased risk of POPC. 19 Smokers with a greater than 20 pack-year smoking history have a higher incidence of POPC than those with a lesser pack-year history.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: Patients who are being considered for renal transplant must undergo thorough preoperative pulmonary evaluation to determine risk of postoperative pulmonary complications. The aim of this study was to determine the relation between the preoperative pulmonary risk factor score and pulmonary complications in patients undergoing renal transplant. Materials and Methods: Medical records of patients who underwent renal transplant at our institution between 2004 and 2015 were retrospectively reviewed. Patient demographics, smoking history, comorbidities, and preoperative pulmonary risk factors (age, oxygen saturation, hemoglobin level, type of incision, duration of surgery, history of lower respiratory tract infection 1 month before surgery, urgency of surgery), and type of pulmonary complications within 1 month after transplant were recorded. Results: Our study included 131 patients (94 male patients; mean age of 38.25 ± 12.96 y). Of total patients, 21(16%) developed complications during the first month after transplant, with 10 of the 21 (7.6% overall) developing pulmonary complications. These complications were pleural effusion (2 patients), pneumonia (3 patients), respiratory failure (2 patients), and pulmonary embolism (1 patient). There were no deaths directly attributed to the pulmonary complications. A significant correlation was observed between the preoperative pulmonary risk factor score and postoperative pulmonary complications in renal transplant recipients (P = .003). A positive correlation between the preoperative pulmonary scores and postoperative pulmonary complications existed among life-long nonsmokers (r = 0.371; P = .003). Conclusions: Renal transplant is an established modality in treatment of chronic renal failure. Prevention of pulmonary complications is essential for successful outcomes following transplant. Health care professionals involved with renal transplant and transplant centers should be aware of preoperative pulmonary risk factors. Patients should be observed so that these risk factors can be reduced before planned transplant. Moreover, we also suggest that smoking history should be considered as a preoperative pulmonary risk factor as it was found to be a factor leading to postoperative pulmonary complications in our study.

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“…An important factor is that more complicated surgery is associated with a longer duration of anaesthesia [22]. WIGHTMAN [25] discusses this in a trial where the incidence of PPC was higher in patients whose operation lasted >30 minutes, but, after further analysis, the group had a higher incidence of PPC independent of the duration of the operation. The result was assumed to be related to the type of operation performed rather than the length of anaesthesia.…”

Section: Duration Of Anaesthesia/surgical Proceduresmentioning

confidence: 99%

Chest physical therapy in surgery: a theoretical model about who to treat

Olsén¹

2005

Breathe

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A prospective survey of the incidence of postoperative pulmonary complications

Cited by 263 publications

References 19 publications

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?

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Chest physical therapy in surgery: a theoretical model about who to treat

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