Pulmonary complications after abdominal surgery in patients with mild-to-moderate chronic obstructive pulmonary disease

Abstract

Postoperative pulmonary complications (PPCs) are one of the most important causes of postoperative morbidity and mortality after abdominal surgery. Although chronic obstructive pulmonary disease (COPD) has been considered a risk factor for PPCs, it remains unclear whether mild-to-moderate COPD is a risk factor. This retrospective cohort study included 387 subjects who underwent abdominal surgery with general anesthesia in a tertiary referral hospital. PPCs included pneumonia, pulmonary edema, pulmonary thromboembolism, atelectasis, and acute exacerbation of COPD. Among the 387 subjects, PPCs developed in 14 (12.0%) of 117 patients with mild-to-moderate COPD and in 13 (15.1%) of 86 control patients. Multiple logistic regression analysis revealed that mild-to-moderate COPD was not a significant risk factor for PPCs (odds ratio [OR] =0.79; 95% confidence interval [CI] =0.31–2.03; P=0.628). However, previous hospitalization for respiratory problems (OR =4.20; 95% CI =1.52–11.59), emergency surgery (OR =3.93; 95% CI =1.75–8.82), increased amount of red blood cell (RBC) transfusion (OR =1.09; 95% CI =1.05–1.14 for one pack increase of RBC transfusion), and laparoscopic surgery (OR =0.41; 95% CI =0.18–0.93) were independent predictors of PPCs. These findings suggested that mild-to-moderate COPD may not be a significant risk factor for PPCs after abdominal surgery.

Comparing laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease under spinal anesthesia and general anesthesia

“…Since opioids can cause excessive sedation, spinal analgesia is a better choice, as it does not have this side effect and therefore lowers the risk of respiratory failure. Several studies have shown that RA can be useful for alleviating the postoperative pain of COPD patients [ 1 , 11 , 12 , 19 , 21 , 22 ]. In our current study, results indicate that patients who underwent LC with SA had significantly less early analgesic requirement and postoperative pain compared to patients who underwent LC with GA; the SA patients had a reduction in pulmonary complications.…”

“…These limitations are diagnosed by taking the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC). The severity of limitations in airflow is determined solely by a patient’s FEV1, which has been shown to predict COPD patient mortality [ 1 ].…”

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

“…Absolute values of forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) were obtained, and percentages of the predicted values for FEV 1 and FVC were calculated using a reference equation obtained in a representative Korean sample [19]. The patients were considered to have COPD if they had a FEV 1 :FVC ratio of <0.70 [20,21]. The airflow limitation degree was classified based on the recommendation of the Global Initiative for Chronic Obstructive Lung Disease; mild, moderate, severe, and very severe airflow limitations were defined as FEV 1 ≥ 80%, 50%-79%, 30%-49%, and <30% of predicted values, respectively [1].…”

Predictors and outcomes of postoperative pulmonary complications following abdominal surgery in a South Indian population

“…Our findings matched those by Kim et al . [ 12 ] who studied 387 patients undergoing abdominal surgery and concluded that in mild to moderate COPD, multiple logistic regressions did not show any increased risk for PPC in comparison with controls.…”