As number of the older patients for general elective surgery is increasing, postoperative pulmonary complications in the elderly are common and are a significant source of morbidity and mortality. We evaluated incidence and predictors of postoperative pulmonary complications in the aged.
We retrospectively collected and analyzed data from 206 patients of 65 years old or more who had undergone general elective nonthoracic surgery. Postoperative pulmonary complications were defined as newly developed atelectasis, pneumonia, pulmonary thromboembolism and acute respiratory failure requiring mechanical ventilation following surgery.
There were 28 (13.6%) postoperative pulmonary complications. Patients with postoperative pulmonary complications had significantly longer duration of operation (p<0.01) and hospital stay (p<0.001), lower PaO2 (p<0.01) and serum albumin (p<0.001), and higher alveolar-arterial oxygen difference [D(A-a)O2] (p<0.01) than patients without postoperative pulmonary complications. Statistically significant predictors of pulmonary complications were as follows: underlying lung disease (odds ratio, 3.2; p<0.01), recent (within 2 weeks) upper respiratory tract infection (OR, 10.6; p<0.05), upper abdominal incision (OR, 4.9; p<0.001), duration of operation of 3 hours or more (OR, 2.9; p<0.05), a PaO2 of less than 75 mmHg (OR, 3.4; p<0.01), a [D(A-a)O2] of 30 mmHg or more (OR, 5.9; p<0.001), a serum albumin of 3.0 g/dL or less (OR, 4.9; p<0.001). Multiple regression analyses revealed four preoperative clinical factors that are independently associated with pulmonary complications: a serum albumin of 3 g/dL or less (OR, 8.0; p<0.01), upper abdominal incision (OR, 5.7; p<0.01), a [D(A-a)O2] of 30 mmHg or more (OR, 4.8; p<0.01), a forced expiratory volume in 1 second (FEV1) of less than 1 L (OR, 7.2; p<0.01).
In the present study, low serum albumin (3 g/dL or less), upper abdominal incision, high [D(A-a)O2] (30 mmHg or more), and low FEV1 (<1 L) were independent predictors of postoperative pulmonary complications after nonthoracic surgery in the aged.
Preoperative spirometry, blood gas analysis and measurement of serum albumin can identify those patients with high risk for pulmonary complications after nonthoracic surgery among the aged.
J. Lee, None.