Postoperative Pneumonia

Martin, Louis F.; Asher, Eleanor F.; Casey, Joseph M.; Fry, Donald E.

doi:10.1001/archsurg.1984.01390160015003

Cited by 49 publications

(8 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8,26,29,[30][31][32] Once chronic pulmonary disease has been taken into account, the presence of respiratory symptoms and smoking habits ceases to be strongly associated with a high incidence of PPCs. Mitchell et al, 11 in a study of 200 patients who underwent general surgery, observed that the contribution of cigarette smoking to PPCs is more likely to occur via its association with hypersecretion of mucus.…”

Section: Discussionmentioning

confidence: 99%

“…1,7,8,10,13,28,29 To select the risk factors to be included in logistic regression for PPC we chose the variables based on p value of the chi square test in a stepdown significance procedure. The variables were included in the following sequence: pneumopathy (p = 0.0001), respiratory symptoms (p = 0.0001), comorbidity (p = 0.007), age over 50 years old (p = 0.03), surgery duration over 210 minutes (p = 0.03), habitual smoking (p = 0.04), current smoking (p = 0.04) and dystrophy (p=0.10) ( Table 2).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

et al. 1999

View full text Add to dashboard Cite

Objective: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. Design: Prospective clinical trial. Setting: A tertiary university hospital. Patients: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. Measurements: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. Results: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). Conclusions: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient's pulmonary status. Key words: abdominal surgery, risk factor, morbidity Abbreviations: BMI = body mass index; FEV1/FVC = forced expiratory volume in the first second divided by forced vital capacity; PPC = postoperative pulmonary complication. respiratory infections, bronchoconstriction and respiratory failure. 3,11,12 Preoperative spirometric tests have been reported to be reliable predictors of PPCs. However, the risk of PPCs is usually estimated in heterogeneous populations and in various surgical procedures, 1,13,14 making it difficult to ascertain the relationship between PPCs and previous spirometric abnormalities. The aim of this study was to follow prospectively a group of patients undergoing an elective upper abdominal surgery to identify those factors associated with an increased risk of developing PPCs using a standard preoperative evaluation. In addition, a subgroup of these patients was submitted to spirometr y to investigate the importance of this test as a predictor of PPCs in this population. Original Article METHODSThis study was performed on 408 consecutive patients undergoing elective abdominal surgery at the Federal University of São Paulo's teaching hospital. All patients were referred for a preoperative assessment (between January 1992 and December 1992), after having been scheduled for elective upper abdominal surgery. All were operated on and observed at the same hospital.Of the 408 patients, 206 were men and 202 were women and their mean age was 55 + 15 years. Operative procedures are...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

et al. 1999

View full text Add to dashboard Cite

show abstract

“…Entre eles, destacamse: idade avançada, presença de doença pulmonar prévia ou outras doenças clínicas, tabagismo e sua intensidade, obesidade, desnutrição, tipo de anestesia, tempo de cirurgia e técnica cirúrgica empregada, valores espirométricos anormais, capacidade diminuída ao exercício e tempo de internação pré-operató-rio prolongado [1][2][3][4][5][6][7][8][9] .…”

unclassified

Validade de um índice prognóstico para ocorrência de complicações pulmonares no pós-operatório de cirurgia abdominal alta

Filardo¹,

Faresin²,

Fernandes³

2002

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

Observar se a freqüência de complicações pulmonares observadas no pós-operatório de cirurgia abdominal pulmonares observadas no pós-operatório de cirurgia abdominal pulmonares observadas no pós-operatório de cirurgia abdominal pulmonares observadas no pós-operatório de cirurgia abdominal pulmonares observadas no pós-operatório de cirurgia abdominal alta eletiva corresponde a freqüência estimada pelo índice prognós-alta eletiva corresponde a freqüência estimada pelo índice prognós-alta eletiva corresponde a freqüência estimada pelo índice prognós-alta eletiva corresponde a freqüência estimada pelo índice prognós-alta eletiva corresponde a freqüência estimada pelo índice prognós-tico de Pereira et al , insuficiência respiratória aguda (11/87;13%), ventilação mecânica prolongada respiratória aguda (11/87;13%), ventilação mecânica prolongada respiratória aguda (11/87;13%), ventilação mecânica prolongada respiratória aguda (11/87;13%), ventilação mecânica prolongada respiratória aguda (11/87;13%), ventilação mecânica prolongada (8/87;9%) e infecção brônquica (2/87;2%). A análise univariada, (8/87;9%) e infecção brônquica (2/87;2%). A análise univariada, (8/87;9%) e infecção brônquica (2/87;2%). A análise univariada, (8/87;9%) e infecção brônquica (2/87;2%). A análise univariada, (8/87;9%) e infecção brônquica (2/87;2%). A análise univariada, seguida pela regressão logística, identificou como fatores de risco seguida pela regressão logística, identificou como fatores de risco seguida pela regressão logística, identificou como fatores de risco seguida pela regressão logística, identificou como fatores de risco seguida pela regressão logística, identificou como fatores de risco independentes para a ocorrência de CPP idade > 56 anos independentes para a ocorrência de CPP idade > 56 anos independentes para a ocorrência de CPP idade > 56 anos independentes para a ocorrência de CPP idade > 56 anos independentes para a ocorrência de CPP idade > 56 anos (p=0,0039), tempo cirúrgico > 210 minutos (p=0,0044) e (p=0,0039), tempo cirúrgico > 210 minutos (p=0,0044) e (p=0,0039), tempo cirúrgico > 210 minutos (p=0,0044) e (p=0,0039), tempo cirúrgico > 210 minutos (p=0,0044) e (p=0,0039), tempo cirúrgico > 210 minutos (p=0,0044) e pneumopatia crônica (p=0,0257). Ao comparar a freqüência de pneumopatia crônica (p=0,0257). Ao comparar a freqüência de pneumopatia crônica (p=0,0257). Ao comparar a freqüência de pneumopatia crônica (p=0,0257). Ao comparar a freqüência de pneumopatia crônica (p=0,0257). Ao comparar a freqüência de CPP que ocorreu em cada uma das oito categorias de risco com a CPP que ocorreu em cada uma das oito categorias de risco com a CPP que ocorreu em cada uma das oito categorias de risco com a CPP que ocorreu em cada uma das oito categorias de risco com a CPP que ocorreu em cada uma das oito categorias de risco com a freqüência estimada, não houve diferença estatisticamente freqüência estimada, não houve diferença estatisticamente freqüência estimada, não houve diferença estatisticamente freqüência estimada, não houv...

show abstract

“…Second, due to increasing economic constraints, high‐risk cases can be identified so that we can prioritise valuable resources to those who need it most. The DAGDA scoring system can assist in maintaining cost‐effective services by focusing on preventive measures versus expensive treatments to treat postoperative pneumonia . The measures mentioned in this programme are not particularly time or cost consuming; overall health‐care costs can be reduced in terms of shortened hospital stay and intensive care unit transfer .…”

Section: Discussionmentioning

confidence: 71%

“…Pneumonia is a serious complication after major and ultramajor operations, and is significantly associated with higher cost of care, longer hospital stays and postoperative mortality. [4][5][6][7][8][9][10] In the present study, we identified the risk factors associated with postoperative pneumonia, used a validated scoring system to predict patients at high risk and were able to prevent postoperative pneumonia and pneumonia-related mortality by providing appropriate protective measures to high-risk patients. This is particularly important for patients with limited time to receive preoperative care and risk factor modification.…”

Section: Discussionmentioning

confidence: 99%

DAGDA score and its evidence‐based pneumonia‐prevention programme

2019

View full text Add to dashboard Cite

Aim The mortality rate of the postoperative pneumonia group is significantly higher than that of non‐pneumonia group. Five of 38 risk factors were found to be significantly related to postoperative pneumonia (P < 0.05) after univariable logistic regression and then multivariable logistic regression analysis: (i) Dependence of activity of daily living; (ii) presence of Ascites; (iii) General anaesthesia; (iv) preoperative Dyspnoea; and (v) ASA (American Society of Anesthesiologists) score ≥3. The DAGDA score was formulated by using these significant risk factors to predict high‐risk patients. The maximum DAGDA score is 18, with an area under the receiver operating characteristic curve of 0.774 (95 per cent confidence interval: 0.716–0.837). Sensitivity and specificity of the DAGDA score with a cut‐off point of 8 are 73.6 and 73.4 per cent, respectively. The external validation of the DAGDA score was examined by using other 4495 patients, which resulted in similar findings. A multidisciplinary team (MDT), including surgeons, respiratory physicians, surgical nursing staff and physiotherapists, was formed, and proactive measures were applied to patients at high risk of developing postoperative pneumonia. Patients and Methods The present study was a prospective cohort study to compare the postoperative pneumonia rate and pneumonia‐related mortality before and after this programme. Results After the implementation of the pneumonia‐prevention programme, there was a decrease in the postoperative pneumonia rate from 4.1 to 3.7 per cent. The 30‐day pneumonia‐related mortality rate significantly dropped from 31.9 to 4.8 per cent (P = 0.016). Conclusion The DAGDA score and the MDT‐led pneumonia‐prevention programme are useful to decrease postoperative pneumonia and prevent pneumonia‐related mortality.

show abstract

Postoperative Pneumonia

Cited by 49 publications

References 14 publications

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

Validade de um índice prognóstico para ocorrência de complicações pulmonares no pós-operatório de cirurgia abdominal alta

DAGDA score and its evidence‐based pneumonia‐prevention programme

Contact Info

Product

Resources

About