Abstract
To identify risk variables leading to early postoperative pulmonary complication (POPC) in thoracic and upper abdominal surgery. 297 patients submitted to elective surgery were classified as low, moderate and high risk for POPC using PORT scale, following Torrington & Henderson (1988). The patients were followed up for 72 hours postoperative. POPC were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. Univariate analysis was applied to study these independent variables: type of surgery, age, nutritional status (BMI), respiratory disease, smoking habit, spirometry and surgical time. Multivariate logistic regression analysis were performed in order to evaluate the relationship between independent and dependent (POPC) variables. POPC incidence was 12.1%. By multivariate logistic regression analysis the variables increasing chance to POPC was cough with yellow mucus (OR= 3.8), thoracic surgery (OR=2.9) compared to abdominal surgery, BMI (OR=1.13), duration of smoking (OR=1.03) and prolonged duration of surgery (OR=1.007). In the thoracic surgery group, multivariate logistic regression analysis showed: wheezing (OR=6.2), BMI (OR=1.15), long time smoking (OR= 1.04) and prolonged duration of surgery (OR= 1.007) related to POPC. The variables occurrence that increased chance to POPC in thoracic and upper abdominal surgery were: cough with yellow mucus, thoracic surgery, BMI, duration of smoking and duration of surgery. Regarding the thoracic surgery group the significance variables were wheezing, BMI, duration of smoking and duration of surgery.
Highlights
CONCLUSÃO As variáveis pré-operatórias que aumentaram a chance de complicação pulmonar pós-operatória (CPP) nas cirurgias de tórax e abdômen alto foram: tosse com expectoração amarela; cirurgia torácica, índice de massa corporal; tabagismo e tempo cirúrgico prolongado
To identify risk variables leading to early postoperative pulmonary complication (PO PC) in thoracic and upper abdominal surgery
297 patients submitted to elective surgery were classified as low, moderate and high risk for POPC using Perioperative Respiratory Therapy (PORT) scale, following Torrington & Henderson (1988)
Summary
1.1 Pneumo- complicações, receberam derivados do nia: aparecimento de opacidade pulmonar sangue, no intra-operatório 15 (15/27) parecente no radiograma de tórax associado a cientes da cirurgia torácica, 13 com respelo menos dois dos seguintes sinais: secre- secção de parênquima pulmonar e dois Considerando inicialmente como variáveis independentes: variáveis clínicas, função pulmonar, tipos de cirurgia e a escala PORT, houve associação entre a ocorrência de CPP e as seguintes variáveis independentes: tosse com expectoração amarela aumentou a chance 3,8 vezes, cirurgia torácica em relação a abdominal aproximadamente três vezes, diminuição da unidade do IMC 1,13 vezes (1/0.887); para cada ano de tabagismo 1,03 vezes. As CPP foram três vezes mais freqüentes nas cirurgias torácicas em relação à abdominal alta, e ainda maiores nas cirurgias com retirada de parênquima pulmonar e com relação à idade, a faixa de até 65 anos apresentou maior incidência de complicações, provavelmente estas duas observações acima se deram porque neste grupo havia maior número de pacientes com co-morbidades pulmonares e fatores clínicos associados. CONCLUSÃO As variáveis pré-operatórias que aumentaram a chance de CPP nas cirurgias de tórax e abdômen alto foram: tosse com expectoração amarela; cirurgia torácica, índice de massa corporal; tabagismo e tempo cirúrgico prolongado. Nas cirurgias de tórax as variáveis encontradas foram: broncoespasmo, índice de massa corporal, tabagismo, tempo cirúrgico prolongado
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