Abstract
Purpose. To assess the incidence of postoperative pulmonary complications (PPCs) in Chinese inpatients, and to develop a brief predictive risk index. Methods. Between August 6, 2012, and August 12, 2012, patients undergoing noncardiac operations in four university hospitals were enrolled. The cohort was divided into two subsamples, cohort 1 to develop a predictive risk index of PPCs and cohort 2 to validate it. Results. 1673 patients were enrolled. PPCs were recorded for 163 patients (9.7%), of whom the hospital length of stay (LOS) was longer (P < 0.001). The mortality was 1.84% in patients with PPCs and 0.07% in those without. Logistic Regression modeling in cohort 1 identified nine independent risk factors, including smoking, respiratory infection in the last month, preoperative antibiotic use, preoperative saturation of peripheral oxygen, surgery site, blood lost, postoperative blood glucose, albumin, and ventilation. The model was validated within cohort 2 with an area under the receiver operating characteristic curve of 0.90 (95% CI 0.86 to 0.94). Conclusions. PPCs are common in noncardiac surgical patients and are associated with prolonged LOS in China. The current study developed a risk index, which can be used to assess individual risk of PPCs and guide individualized perioperative respiratory care.
Highlights
More than 230 million major surgical procedures are undertaken each year worldwide [1] and postoperative complications imposed a significant clinical and economic burden to surgical patients as well as the public health systems [2, 3]
Identifying perioperative risk factors of pulmonary complications (PPCs) is an important step toward improving quality of care in surgical patients, which has been already explored in several studies [11, 12, 18]
Most PPCs occurred after upper gastrointestinal surgery (40.4%), followed by thoracic (38.8%), neurosurgery (22.2%), kidney (14.3%), hepatobiliary (13.5%), and lower gastrointestinal surgeries (11.8%)
Summary
More than 230 million major surgical procedures are undertaken each year worldwide [1] and postoperative complications imposed a significant clinical and economic burden to surgical patients as well as the public health systems [2, 3]. PPCs occur more frequently than cardiac complications [10]. Though it came to wide attention in recent years, the literature investigating the incidence and outcome of PPCs in Chinese inpatients remains scarce. Previous studies demonstrated that PPCs were associated with a series of perioperative risk factors, such as age, smoking, chronic obstructive pulmonary disease (COPD), type of surgery, and serum albumin [4, 6, 7, 11,12,13,14]. Identifying perioperative risk factors of PPCs is an important step toward improving quality of care in surgical patients, which has been already explored in several studies [11, 12, 18]
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