Cough Impairment and Risk of Postoperative Pulmonary Complications After Open Upper Abdominal Surgery

Abstract

BACKGROUND: Cough impairment is often described as part of the pathophysiological basis of postoperative pulmonary complications (PPCs). However, there have been few studies examining cough effectiveness and its relationship with PPCs following open upper abdominal surgery. The goal of this study was to estimate (1) changes in cough efficacy after upper abdominal surgery through the assessment of peak cough flow and (2) the extent to which cough impairment is associated with postoperative pain, FVC, and risk of PPCs. METHODS: This prospective cohort study assessed 101 subjects (45% male, 56 ؎ 16 y old) admitted for elective upper abdominal surgery. Measurements of peak cough flow and FVC were performed on the day before surgery and repeated on postoperative days 1, 3, and 5. PPCs were assessed daily by a pulmonologist blinded to the cough measurement results. RESULTS: Peak cough flow dropped to 54% of the preoperative value on postoperative day 1 and gradually increased on postoperative days 3 (65%) and 5 (72%) (P < .05). On all postoperative days, peak cough flow was strongly correlated with FVC (P < .001) and weakly correlated with pain (P ‫؍‬ .006). Six subjects (6%) developed PPCs. The association between peak cough flow and risk of PPCs was not statistically significant (unadjusted odds ratio of 0.80, 95% CI 0.45-1.40, P ‫؍‬ .44; adjusted odds ratio of 0.66, 95% CI 0.32-1.38, P ‫؍‬ .41). CONCLUSIONS: Cough effectiveness is impaired after upper abdominal surgery. Postoperative restrictive lung dysfunction seems to be associated with this impairment. There is no significant association between peak cough flow and PPCs; however, cough impairment might result in clinically important consequences in a high-risk population.

Acute Pain Service: A 10‐Year Experience

“…This, along with other strategies that have been previously described, accounts for a very low mortality and complication rate. The APS is crucial to obtaining these results, as the benefits deriving from a pain‐free postoperative period are multifaced: earlier mobilization, earlier hospital discharge, and a lower incidence of postoperative respiratory and cardiovascular complications account for a better outcome and a reduction of hospitalization costs …”

“…The APS is crucial to obtaining these results, as the benefits deriving from a pain-free postoperative period are multifaced: earlier mobilization, earlier hospital discharge, and a lower incidence of postoperative respiratory and cardiovascular complications account for a better outcome and a reduction of hospitalization costs. 4,5 Two postoperative pain surveys were conducted in Italy in 2006 and 2012: the POPSI and POPSI-2. 24,25 These surveys highlighted substantial regional differences and a weak presence of acute pain services: 46% in 2006 and 58.5% in 2012 of responders worked in a hospital with an active APS.…”

“…Pain may amplify autonomic reflexes, triggering hypertensive crisis or vagal syndromes that may result in severe complications and modify the endocrine response of patients, raising cortisol and catecholamine levels . Abdominal or thoracic pain may impair patients’ ability to cough, contributing to the development of atelectasis and further pulmonary complications . Additionally, pain may reduce mobilization, resulting in increasing length and costs of hospital stay…”

“…3 Abdominal or thoracic pain may impair patients' ability to cough, contributing to the development of atelectasis and further pulmonary complications. 4 Additionally, pain may reduce mobilization, resulting in increasing length and costs of hospital stay. 5 Acute pain services (APS) are becoming a widely applied solution in hospitals around the world to properly and successfully manage postoperative pain.…”

Rectal, central venous, gastric and bladder pressures versus esophageal pressure for the measurement of cough strength: a prospective clinical comparison

“…Thus, the inability to cough forcefully enough to be effective would increase the risk of pulmonary complications such as atelectasis or pneumonia. This inability is observed in neuromuscular or respiratory diseases and is particularly likely after abdominal or thoracic surgery, when pain, surgical injury and/or the residual effect of anesthetics come into play [ 1 – 3 ].…”