Chest
Clinical Investigations: SurgeryPredictors of Postoperative Pulmonary Complications Following Abdominal Surgery
Section snippets
Study Population
The target population was adults undergoing a scheduled abdominal surgical procedure at four institutions. Inclusion criteria were as follows: scheduled for nonlaparoscopic elective procedure; age ≥18 years; anticipated postoperative stay of ≥48 h; first general anesthesia of hospitalization; had not previously participated in study; and able to understand informed consent. Subjects were excluded for the following reasons: postoperative mechanical ventilation required; preoperative evidence of
RESULTS
Of the 630 subjects initially enrolled into the study, 69 were excluded due to postoperative mechanical ventilation (n=31), reoperation during first 6 days (n=9), change in type of surgery scheduled (n=9), confirmed preoperative atelectasis (n=10), died in operating room or during first 6 postoperative days due to nonrespiratory cause (n=5), and postoperative stay <48 h (n=5). Thus, 561 subjects were available for model building and validation. Of these, 126 (22.5%) developed a PPC.
Random
DISCUSSION
The overall incidence of PPCs following abdominal surgery is approximately 20%; however, estimations vary widely in the literature (20 to 69%).4,15 This variability is due primarily to the type of PPC studied, clinical criteria used in the definition, and differing surgical populations. In this study, the incidence of PPCs was 22.5% using a combined definition for both atelectasis and pneumonia. Consistent with past findings using a similar definition, Hall et al4 reported an incidence of 23.3%
CONCLUSION
In summary, this prospective study identified six independent risk factors in the development of PPCs following abdominal surgery: age ≥60 years, BMI ≥27, history of cancer, impaired cognitive function in the preoperative setting, upper abdominal, or both upper/lower abdominal incision site and positive smoking history within the past 8 weeks. Validation of this risk model is ongoing in an independent sample of abdominal surgical patients. Continued work is needed in this area as a reliable and
ACKNOWLEDGMENT
The investigator would like to acknowledge Drs. William J. Martin II and Fredric Wolinsky for their direction and support of this study and manuscript preparation.
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Reprint requests: Dr. Brooks-Brunn, Indiana University Medical Center, Pulmonary, Critical Care, and Occupational Medicine, 550 N University Blvd, UH5450, Indianapolis, IN 46202-5250
Funded by NINR-NRSA F32NR06776–03, Indiana State Department of Health Preventative Health Block Grant 1992–1995, Sigma Theta Tau International Research Grant 1992.