Abstract
BackgroundPostoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected patients undergoing major elective abdominal surgery was to determine the incidence and effects of PPC.MethodsData on all major elective abdominal operations performed over a 2-week period in December 2014 were collected in six hospitals. The primary outcome measure of PPC at 7 days was used. Univariate and multivariate analyses were performed to investigate how different factors were associated with PPC and the effects of such complications.ResultsTwo hundred sixty-eight major elective abdominal operations were performed, and the internal validation showed that the data set was 99 % accurate. Thirty-two (11.9 %) PPC were reported at 7 days. PPC was more common in patients with a history of chronic obstructive pulmonary disease compared to those with no history (26.7 vs. 10.2 %, p < 0.001). PPC was not associated with other patient factors (e.g. age, gender, body mass index or other comorbidities), type/method of operation or postoperative analgesia. The risk of PPC appeared to increase with every additional minute of operating time independent of other factors (odds ratio 1.01 (95 % confidence intervals 1.00–1.02), p = 0.007). PPC significantly increase the length of hospital stay (10 vs. 3 days). Attendance to the emergency department within 30 days (27.3 vs. 10.6 %), 30-day readmission (21.7 vs. 9.9 %) and 30-day mortality (12.5 vs. 0.0 %) was higher in those with PPC.ConclusionsPPC are common and have profound effects on outcomes. Strategies need to be considered to reduce PPC.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0037-0) contains supplementary material, which is available to authorized users.
Highlights
Postoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality
Demographics Over the 2-week period, a total of 268 consecutive major elective abdominal operations were performed in the six hospitals
Outcomes at day 7 and 30 (Table 2) A total of 32 (11.9 %) PPC were reported at 7 days, and suspected pulmonary infection was the most common (n = 24, 9 %)
Summary
Postoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected patients undergoing major elective abdominal surgery was to determine the incidence and effects of PPC. 16 % will suffer a complication within 30 days (Kazaure et al 2012) These include well-defined complications e.g. thromboembolic complications (NICE 2010) and surgical site infections (NICE 2013) and others which are likely to be under-reported as they do not form part of the current hospital quality measures. One set of under-reported complications are postoperative pulmonary complications (PPC). These include a spectre of clinical conditions. These can be self-limiting, require wardbased interventions e.g. antibiotics or physiotherapy, or readmission to critical care, reintubation and even death
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