Perioperative risk factors for pulmonary complications after non-cardiac surgery

Gupta, Surbhi; Fernandes, Roshan Joseph; Rao, Joseph Sushil; Dhanpal, Radhika

doi:10.4103/joacp.joacp_54_19

Cited by 29 publications

(25 citation statements)

References 26 publications

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“…This result is consistent with the ndings of a multivariate analysis conducted by Sah and colleagues of the gastric cancer treatments provided by a specialized center: if the blood loss volume exceeded 500 ml, it was associated with early postoperative complications (OR, 2.86; 95% CI, 1.67-4.92). (44) Although the presence of a nasogastric (NG) tube has been reported by some studies to be a PPC risk factor (45), there were no signi cant differences between its use and non-use in terms of the PPC incidences in our study. One explanation is that nasogastric decompression was not a routine procedure at our hospital during the study period.…”

Section: Intraoperative and Postoperative Parameterscontrasting

confidence: 59%

Do ARISCAT Scores Help to Predict the Incidence of Postoperative Pulmonary Complications in Elderly Patients After Upper Abdominal Surgery? An Observational Study at a Single University Hospital.

Nithiuthai¹,

Siriussawakul²,

Triyasunant³

et al. 2021

Preprint

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BackgroundThe incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais.MethodsA retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores.ResultsIn all, 1,100 elderly postoperative patients were analyzed. Their mean age was 73.62 years, and 48.5% were male. The incidence of PPCs was 7.72%, with the most common being pleural effusion, atelectasis, and pneumonia. The average hospital and intensive care unit stays of the PPC patients were significantly longer than those without PPC (25.35 versus 7.30 days, with p < 0.0001; and 8.36 versus 2.84 days, with p 0.010, respectively). Almost 90% of the PPC patients had intermediate-to-high ARISCAT scores, with an average of 43.15 ± 13.58.ConclusionsPPCs are common in elderly patients and are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of geriatric Thai patients into PPC risk groups. Its usage might help to raise healthcare awareness and improve the perioperative management of elderly Thai patients. Moreover, the ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.

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Section: Intraoperative and Postoperative Parameterscontrasting

confidence: 59%

Do ARISCAT Scores Help to Predict the Incidence of Postoperative Pulmonary Complications in Elderly Patients After Upper Abdominal Surgery? An Observational Study at a Single University Hospital.

Nithiuthai¹,

Siriussawakul²,

Triyasunant³

et al. 2021

Preprint

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“…Subsequent investigators have validated the ARISCAT score for predicting the risk of developing PPCs, including a recent study of 1170 patients undergoing noncardiac surgery, which showed that patients with intermediate and high risk based on ARISCAT were found to have increased risk of PPCs. 10 …”

Section: Acute Respiratory Failure In the Perioperative Patientmentioning

confidence: 99%

“…In the most severe form, massive embolic events involve complete circulatory collapse, characterized by shock and/or syncope. 10 The physical examination is often unremarkable, the most common findings being tachypnea and tachycardia. Jugular vein distention, a parasternal heave, a pulsatile liver, and a loud S2 on cardiac can also be present.…”

Section: Acute Respiratory Failure In the Perioperative Patientmentioning

confidence: 99%

Acute Respiratory Failure

Summers¹,

Todd²,

Vercruysse³

et al. 2022

Perioperative Medicine

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Acute respiratory failure occurs when the lungs fail to oxygenate arterial blood adequately and it is one of the commonest postoperative complications. The preoperative identification of risk factors for postoperative acute respiratory failure allows identification of those patients who may benefit from preoperative optimization and increased postoperative vigilance. Multiple postoperative pulmonary complications are associated with acute hypoxemic respiratory failure and this chapter discusses atelectasis, pulmonary embolism, aspiration, and acute respiratory distress syndrome in detail, as well as providing a unified clinical approach to the acutely hypoxemic perioperative patient.

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“…8 Another study which involved 1170 patients who underwent non-cardiac surgery had a postoperative pulmonary complication rate of 5%. 9 Out of these patients, pulmonary infection was the most common followed by atelectasis, bronchospasm and pulmonary embolism. 9 Developing postoperative respiratory complications is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs.…”

Section: Problemmentioning

confidence: 99%

“…9 Out of these patients, pulmonary infection was the most common followed by atelectasis, bronchospasm and pulmonary embolism. 9 Developing postoperative respiratory complications is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. 1 Mortality is increased both in the short and long terms in patients who develop a postoperative respiratory complication.…”

Section: Problemmentioning

confidence: 99%

Improving the use of the ‘COUGH’ bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee

Livie

Hilton-Christie

2020

BMJ Open Qual

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Developing respiratory complications postoperatively is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. The incidence of postoperative respiratory complications varies from 1% to 23%. Given that postoperative respiratory complications are relatively common and costly, there have been various studies which look at ways to reduce the risk of these occurring. One such protocol is the ICOUGH bundle which stands for Incentive spirometry, Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation. This has been adapted locally to the Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation (COUGH) bundle which consists of these components excluding incentive spirometry. Within our surgical high dependency unit (HDU), the COUGH bundle should be implemented in patients who have a moderate or high risk of developing postoperative respiratory complications with an Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 26 or above. Studies have shown that the ICOUGH bundle has reduced rates of pneumonia and unplanned intubation in general surgical and vascular patients. Baseline data taken from surgical HDU showed that the COUGH bundle was not well implemented. One out of eight patients who had an ARISCAT score greater than 26 had the COUGH bundle implemented on admission to the unit. Three out of eight patients had the ARISCAT score documented in their admission medical review. One patient who should have received the bundle, but did not, developed a hospital acquired pneumonia postoperatively. To address this issue, we aimed to increase awareness surrounding the COUGH bundle and to increase the number of patients who had the COUGH bundle started on admission. This quality improvement project had four cycles (plan, do, study, act) and after these, 100% of patients who had an ARISCAT score of 26 or more had the COUGH bundle implemented.

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Perioperative risk factors for pulmonary complications after non-cardiac surgery

Cited by 29 publications

References 26 publications

Do ARISCAT Scores Help to Predict the Incidence of Postoperative Pulmonary Complications in Elderly Patients After Upper Abdominal Surgery? An Observational Study at a Single University Hospital.

Do ARISCAT Scores Help to Predict the Incidence of Postoperative Pulmonary Complications in Elderly Patients After Upper Abdominal Surgery? An Observational Study at a Single University Hospital.

Acute Respiratory Failure

Improving the use of the ‘COUGH’ bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee

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