The frequency of, and risks for postoperative pulmonary complications (PPCs) after abdominal surgery (AS) are incompletely understood. Definitions of PPCs have been variable and the range of PPCs reported in the literature is wide (2-19%). In the present study we have used a definition of PPCs that is clinically relevant in terms of affecting key outcomes including morbidity, mortality, and length of stay (LOS).
Data for 200 consecutive Pts in 2004 were collected using CPT codes to identify AS performed at our hospital. PPCs were defined as 2 or more of the following for at least 2 consecutive days, occurring within 7 days of surgery: 1) new cough /sputum production, 2) physical exam c/w segmental or greater atelectasis or pneumonia 3) radiographic findings c/w segmental or greater atelectasis or pneumonia 4) temp>38 C. Additionally, exacerbation of preexisting lung disease, respiratory failure, and pulmonary embolism defined PPCs. Incentive spirometry is used routinely at our hospital after AS. A stepwise multiple logistic regression model was used for statistical analysis.
PPCs occured in 9 of 200 (4.5%) cases (Table I). There were no PPCs after laparoscopy. There were no deaths. Risk factors for PPCs identified in univariate analyses are shown in Table II. Nasogastric tubes and a history of cardiac disease independently predicted risk in multivariate analysis. LOS was statistically greater in patients with PPCs (OR=1.17, 95% CI 1.08-1.27, p=.001).
These data suggest a low incidence of PPCs after AS. The reasons for a lower frequency of PPCs reflected by these data compared to many prior studies are multi-factorial including a more clinically relevant definition of PPCs, improved technology, and use of less invasive techniques (laparoscopy).
Morbidity and potential mortality from PPCs can be reduced by preoperative risk assessment and appropriate perioperative management.
Table IPPC DescriptionnAtelectasis3Pneumonia / Atelect.1Resp. Failure2Pulm. Emboli2COPD exacerb.1Table II—
Risk Factors for Post Operative Pulmonary ComplicationsRisk FactorOR95% CIp ValueAge1.041.002-1.088.039Smoking (ever)4.01.10-14.53.035COPD9.11.82-100.97.072Cardiac disease5.371.40-20.57.014ASA4.991.50-16.62.009Anesthesia time7.131.23-41.41.029Upper abdo incision8.881.06-74.26.044NG tube39.974.90-326.15.001Non-pulm complic4.361.03-18.43.045
Fayez Bader, None.