In a previous prospective study(Am J Respir Crit Care Med.2004;169:A105) we reported a low incidence (3.1%) of postoperative pulmonary complications (PPCs) after elective gynecologic surgery (EGS) for non-malignant disorders. This was considerably less than the incidence of PPCs (11%) after hysterectomy for all causes reported by Brooks-Brunn (Clin Nurs Res. 2000;9:27-46). To assess whether the low frequency of PPCs that we found was due in part to the study itself (study team encouraged appropriate use of incentive spirometry or deep breathing exercises), we performed a retrospective study of PPCs after EGS for malignant and non-malignant disorders in the period immediately preceding our prospective study.
We reviewed the records of all patients (Pts) at our 450 bed community hospital undergoing EGS from 11/1/01 through 10/31/02. PPCs were defined as 2 or more of the following for 2 or more consecutive days: 1) new cough/sputum, 2) exam c/w atelectasis or pneumonia, 3) Temp greater than 38C, 4) chest radiograph showing atelectasis or new infiltrate. Statistical analyses utilized Fishers exact test. P<0.05 was the level of significance for all comparisons.
440 records were reviewed. 56 Pts not undergoing open abdominal procedures were excluded. Of 384 remaining Pts, PPCs occurred in 7 (1.8%). Variables which might influence the risk for PPCs are compared in Pts with and without PPCs in the Table.
Characteristics of Patients With and Without Postoperative Pulmonary Complications After Gynecologic SurgeryAge (mean)SmokeLung DiseasePathology (No. Malignancies)PPCs (n=7)48.72 (28.6%)02 (28.6%)No PPCs (n=377)43.054(14.3%)33 (8.8%)27(7.16%)P value for difference0.0880.270.830.09
This retrospective data confirms the results of our prospective study. PPCs after elective gynecologic surgery are infrequent. Older age, smoking, history of lung disease, and gynecologic malignancy were not statistically significant risks for development of PPCs, although age and malignancy approached the level of significance.
The incidence of PPCs after EGS is low. The risk for PPCs in Pts undergoing EGS does not appear to be influenced by age, smoking, history of lung disease, or diagnosis of gynecologic malignancy.
B. Khoury, None.