Chest
clinical investigationsRisk of Pulmonary Complications After Elective Abdominal Surgery
Section snippets
Study Cohort/Ascertainment of Cases
This study was approved by the Institutional Review Board at the University of Texas Health Science Center at San Antonio. The patient cohort included all elective intra−abdominal operations performed between 1982 and 1991 (n=2,291) at Audie L. Murphy Division of the South Texas Veterans Health Care System. This facility is a 650−bed hospital affiliated with the University of Texas Health Science Center at San Antonio and has a large South Texas catchment area. Patients were identified from a
Results
Table 1 shows overall characteristics of the 82 cases and 82 control subjects according to unmatched descriptive analyses. All 18 deaths occurred among cases. Hospital and ICU stays were significantly longer for cases than control subjects. Cases had significantly worse comorbidity scores and greater mean pack−years of smoking compared with control subjects. Preoperative diagnostic spirometry was obtained in similar proportions of cases (48%) and control subjects (46%), but no single
Discussion
In this study of veterans undergoing elective abdominal operations, preoperative clinical factors independently associated with pulmonary complications included abnormal results of lung examination or abnormal chest radiograph, the Goldman cardiac risk index, and overall comorbid disease burden as measured by the Charlson comorbidity index. Abnormal spirometric findings were not associated with complications on univariate or multivariable analysis. The degree of obstructive lung disease
Pulmonary
- 1.
Pneumonia: radiographic evidence and antibiotics
- 2.
Possible pneumonia: radiographic evidence but no IV antibiotics OR normal chest radiograph, but IV antibiotics given
- 3.
Respiratory failure: ventilator dependence for >1 postoperative day or reintubation
- 4.
Bronchospasm: clinical diagnosis resulting in change in therapy
- 5.
Tracheobronchitis: purulent sputum with normal chest radiograph, not treated with IV antibiotics
- 6.
Pleural effusion: resulting in thoracentesis
Cardiac
- 1.
Transient ischemia: angina or ECG read as ischemia by physician
- 2.
Supraventricular tachycardia: resulting in pharmacologic intervention or care in the ICU
- 3.
Ventricular ectopy: resulting in therapy
- 4.
Transmural myocardial infarction: increased MB fraction of creatinine phosphokinase plus Q waves or characteristic ST elevation on ECG
- 5.
Nontransmural myocardial infarction: increased MB fraction plus ST depression or T−wave changes on ECG for more than 24 h
- 6.
Possible infarction: suspected but criteria for
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(1993) - National Center for Health Statistics. Detailed diagnoses and procedures, national hospital discharge survey, 1990...
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