Pulmonary complications after non-cardiac surgeries: temporal patterns and risk factors

Abstract

Background: Postoperative complications are the primary determinants of survival following major surgery. We aimed to characterize the early perioperative risk factors for postoperative pulmonary complications (POPCs) in patients undergoing major non-cardiac surgeries. Methods: This study utilized a multicenter prospective observational cohort design. Adult patients undergoing noncardiac surgeries and admitted to 21 Brazilian ICUs were screened for inclusion in the study. POPCs were defined as the presence of acute pulmonary oedema, nosocomial pneumonia, and extubation failure in the postoperative period. Results: Of the 581 patients enrolled, 110 (19%) had at least one POPC, of whom 5% had acute pulmonary oedema, 10% extubation failure while 10% had pneumonia. Most cases of pulmonary oedema occurred in the first week after surgery, while pneumonia was more frequently a later occurrence. The mortality rate was significantly higher in the group with POPCs compared to the group of patients without POPCs (62% vs. 11%, RR: 5.1, 95% CI: 4.23-7.69; P < 0.001). A low functional capacity (RR: 4.6, 95% CI: 2.1-10.0), major surgery (RR: 3.6, 95% CI: 1.2-10.7), preoperative hemodynamic instability (RR: 3.4, 95% CI: 1.1-10.6), alcoholism (RR: 3.3, 95% CI: 1.0-10.7), unplanned surgery (RR: 2.3, 95% CI: 1.0-5.2), the SOFA score (RR: 1.1, 95% CI: 1.0-1.2), and increased central venous pressure (RR: 1.1, 95% CI: 1.0-1.1) were independent predictors of POPCs. Conclusions: Pulmonary complications are common in intensive care units after major non-cardiac surgeries. Awareness of the risk factors for POPCs may help multidisciplinary teams develop strategies to prevent these complications.

The predictive value of three risk score scales for postoperative pulmonary complications in critically ill patients: A retrospective cohort study

“…Postoperative pulmonary complications (PPC S ) are common complications after surgery, with an incidence of approximately 40%. [1][2][3] There are no uniform criteria for de ning PPC S , with some researchers treating the combined outcome of multiple pulmonary diseases as a pulmonary complication and others treating a speci c pulmonary disease or a respiratory condition requiring special measures to manage postoperatively as a pulmonary complication; furthermore, in 2015, according to the European Society of Anesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM), pulmonary infection, respiratory failure, pulmonary atelectasis, aspiration pneumonia, bronchospasm, pleural effusion and pneumothorax were included in the scope of PPC S , 4 (see Table 1). PPC S are pulmonary abnormalities and dysfunctions that occur postoperatively with clinical manifestations and negatively affect the disease process; they can adversely affect the patient's cardiovascular and immune systems, thereby prolonging the hospital stay and increasing hospital costs.…”

Effect of electrical impedance-guided PEEP in reducing pulmonary complications after craniotomy: study protocol for a randomized controlled trial

“…Postoperative pulmonary complications (PPCs) are common, with an incidence of 39% [ 1 – 3 ]. Miskovic et al [ 4 ] broadly described PPCs as “complications affecting the respiratory system after anesthesia and surgery,” while most studies describe PPCs as atelectasis, pneumonia, pulmonary edema, exacerbation of underlying chronic lung disease, or postoperative respiratory failure [ 5 ].…”