Chest
Volume 111, Issue 3, March 1997, Pages 564-571
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Clinical Investigations: Surgery
Predictors of Postoperative Pulmonary Complications Following Abdominal Surgery

https://doi.org/10.1378/chest.111.3.564Get rights and content

Study objective

To determine how risk factors could be combined to best predict the development of a postoperative pulmonary complication (PPC) following abdominal surgery.

Design

Prospective model-building study. Logistic regression models were developed using significant risk factors identified in the univariate analysis.

Setting

Four midwestern hospitals.

Patients

Convenience sample of 400 patients who underwent abdominal surgical procedures between January 1993 and August 1995.

Measurements and results

Multicriteria outcome for postoperative pulmonary complication used to collectively assess atelectasis and pneumonia. Twenty-three risk factors were assessed. Six risk factors were identified as independent by logistic regression: age ≥60 years (adjusted odds ratio [Adj OR], 1.89); impaired preoperative cognitive function (Adj OR, 5.93); smoking history within the past 8 weeks (Adj OR, 2.27); body mass index ≥27 (Adj OR, 2.82); history of cancer (Adj OR, 2.23); and incision site-upper abdominal or both upper/lower abdominal incision (Adj OR 2.30).

Conclusions

These results provide a framework for identifying patients at risk of developing a PPC following abdominal surgery. A reliable and valid risk index could be used clinically to guide preoperative and postoperative pulmonary care and target limited resources for patients at risk.

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.

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