PURPOSE: Postoperative pulmonary complications are common occurrences following thoracic and cardiac surgery. To determine the risk factors for the development of postoperative pulmonary complications after a cardiac or thoracic surgery.
METHODS: Inclusion criteria were patients >/= 18 y.o. who underwent cardiac or thoracic surgery and first general/local anesthesia. Excluded were patients with pre-operative pneumonia or atelectasis and mechanical ventilation.Risk factors are gender, age, body mass index, weight loss of > 10%, sensorium, functional status,cough, congestive heart failure,wheezing, unstable angina, chronic obstructive pulmonary disease, steroid use, cerebrovascular accident, cancer, myocardial infarction within 6 months, hypertension, diabetes mellitus, kidney/liver disease, smoking, alcohol intake, preoperative pulmonary education, spirometry, blood gas, ejection fraction, arrhythmia, type of surgery and anesthesia, anesthesia and mechanical ventilation duration, blood transfusion, intraaortic balloon use. Descriptive statistics and associations of risk factors were analyzed using chi square and Fischer’s Exact Test. Risk factors were entered in a logistic regression model. Scoring system was developed.
RESULTS: Total of 660 patients included;mean age (57 +/− 15), BMI (24.165 +/− 4.42). Significant risk factors are; male gender (OR 1.70), age, COPD (OR 3.52), steroid use(OR 7.72), myocardial infarction (OR 2.73), renal insufficiency (OR 2.21), CHF (OR 2.52), cough (OR 2.09), wheezing (OR 2.25), unstable angina (OR 2.52),absence of pulmonary education (OR 2.04),cardiac or thoracic surgery (OR 5.67), general anesthesia (OR 8.38), longer anesthesia (OR 1.00), bypass (OR 1.00), ischemic time (OR 1.00), blood transfusion(OR 3.95), intraaortic balloon use (OR 3.41),mechanical ventilation > 24 hrs (OR 1.03). These risk factors prolong hospital stay (16.88 +/− 13.21 days). Postoperative death was associated with pulmonary complications (OR 6.0). Scores obtained generated a cardio-pulmonary risk index.
CONCLUSION: Combining preoperative and intraoperative risk factors, the study revealed that significant factors predictably increase the odds to develop pulmonary complications following cardiac or thoracic surgery. The study was able to formulate risk index scoring system.
CLINICAL IMPLICATIONS: Use of risk factor scoring index was emphasized to identify patients at great risk and guide clinicians in anticipatory management.
DISCLOSURE: Ogee Mer Panlaqui, None.