Postoperative Pulmonary Complications after Laparotomy

Smith, Peter R.; Baig, Muhammad A.; Brito, Verónica; Bader, Fayez; Bergman, Michael; Alfonso, Antonio E.

doi:10.1159/000253881

Cited by 65 publications

(60 citation statements)

References 43 publications

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“…This variability was attributed to differences in criteria used to define PPCs, assessment times, and inclusion/exclusion criteria. The incidence of PPCs observed in our study is comparable to that (7%) observed by Smith et al 14 and Canet et al, 15 who used similar diagnostic criteria. A study by our research group also found similar PPC rates (7.2%).…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2015

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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.

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Section: Discussionsupporting

confidence: 90%

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

et al. 2015

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“…Patients above critical thresholds presented a significant increase in respiratory complications, which are of particular concern after open surgery . The rate of 12% in the present cohort, however, is within the reported range .…”

Section: Discussioncontrasting

confidence: 57%

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

et al. 2018

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Aim The present study aimed to analyse fluid management and to define optimal fluid‐related thresholds for elective open colorectal surgery. Method A retrospective analysis was made of all consecutive elective open colorectal resections performed in our tertiary centre between May 2011 and May 2017. The main outcomes were postoperative complications [overall (I–V) and severe (IIIB–V) according to the Clavien classification], respiratory complications and postoperative ileus (POI). Critical thresholds regarding perioperative fluid management and postoperative weight gain were identified by using receiver operator characteristic (ROC) analysis. Independent risk factors for overall complications were identified by multivariable logistic regression analysis. Results Of 121 patients who had open operations, 84 (69%) had some complication and 26 (21%) had severe complications. Respiratory complications and POI occurred in 15 (12%) and 46 patients (38%), respectively. The thresholds for intravenous fluids were 3.5 l at postoperative day (POD) 0 [area under ROC curve (AUROC) 0.7 for any 0.69 for respiratory complications] and 3.5 kg weight gain at POD 2 (AUROC 0.82 for respiratory complications). Multivariable analysis revealed weight gain of > 3.5 kg at POD 2 (OR 5.9; 95% CI 1.3–16.6) as a significant risk factor for overall complications. Acute kidney injury was observed in five patients (4%), three (5%) in the group with > 3.5 l at POD 0 and two (3%) in the group with < 3.5 l at POD 0 (P = 0.64). Creatinine increase was transitory and all patients regained baseline levels before discharge. Conclusion A weight gain of > 3.5 kg at POD 2 has been identified as the critical threshold for overall and respiratory complications and prolonged length of stay after open elective colorectal surgery.

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“…In a recent study Smith PR et al who conducted a retrospective study of all laparotomies in adult patients on general service at university affiliated hospital 2004, out of 359 patients 25 (7.0%) developed postoperative pulmonary complications. 18 In the present series author found overall incidence of post-operative complications to be 30.2% which is comparable to other series.…”

Section: -15supporting

confidence: 83%

Incidence of post-operative pulmonary complications following emergency laparotomy in tertiary care centre in Vindhya region of Madhya Pradesh, India

Gangwal¹,

Singh²

2018

Int Surg J

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INTRODUCTIONPulmonary complications after abdominal surgery, including pneumonia, atelectasis and respiratory failure, are significant cause for patient suffering, prolonged hospital stay and increased mortality rate.1-3 Although postoperative pulmonary complications (PPC) are recognized to be common, reported incidence is variable, ranging from 9% to 40%, probably due to methodological discrepancies among various studies.4,5 A number of risk factors for PPC following elective nonthoracic surgery, derived from clinical history, physical examination, lung function tests, chest X-ray and other pre or intraoperative elements, has been described. 6 However, studies on incidence and predictors of pulmonary complications after emergency surgery are very scarce. Emergency surgery has been reported to ABSTRACT Background: Pulmonary complications after abdominal surgery, including pneumonia, atelectasis and respiratory failure, are significant cause for patient suffering, prolonged hospital stays and increased mortality rate. There are well documented cases of atelectasis, pneumonia, aspiration pneumonitis, Acute respiratory distress syndrome, pleural effusion, empyema, tracheobronchitis etc. Present study aims at studying the incidence of pulmonary complications following emergency laparotomy. Methods: A total of 271 patients who got admitted through SOPD, casualty or transferred from other departments and underwent emergency laparotomy during the period of study were included in the study irrespective of the age and sex. Post operatively patients were regularly monitored and with advent of clinical and investigative findings post-operative pulmonary complications were recorded and incidence was calculated. Results: The mean age of the patients in present study was 36.1 and standard deviation of 15. Out of 271 patients, 219 were males 52 were females. Most common etiology of peritonitis was Peptic perforation (35.4%) followed by ileal perforation (23.6%). Incidence of post-operative pulmonary complications in present study was 30.2%. Conclusions: Post-operative pulmonary complications continue to be a significant morbidity following emergency laparotomies. Preoperative risk factors include smoking history, pre-existing lung disease and cardiac dysfunction. Emergency nature of the procedure, long duration operation and midline incision are the other factors that can increase the risk of PPC. Early identification and aggressive treatment goes a long way to tide over the progress to a life-threatening state.

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Postoperative Pulmonary Complications after Laparotomy

Cited by 65 publications

References 43 publications

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

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

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

Incidence of post-operative pulmonary complications following emergency laparotomy in tertiary care centre in Vindhya region of Madhya Pradesh, India

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