Abstract
Despite a substantial population of patients with a restrictive spirometric pattern, few studies have evaluated postoperative pulmonary complications (PPCs) after non-cardiothoracic surgery in these patients. We conducted a retrospective cohort study of 681 adults with a normal or restrictive spirometric pattern who were referred for preoperative evaluation of PPC risk before non-cardiothoracic surgery between March 2014 and January 2015. Overall, 8.7% (59/681) of study participants developed a PPC following non-cardiothoracic surgery. The occurrence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with normal spirometry (12.4% [35/282] vs. 6.0% [24/399], P = 0.003). The occurrence of PPCs increased across the categories of restrictive spirometric pattern severity (6.0% with a normal spirometric pattern vs. 6.5% with a mild restrictive spirometric pattern [60 ≤ forced vital capacity (FVC) < 80% predicted] vs. 21.2% with a moderate-to-severe restrictive spirometric pattern [FVC < 60% predicted], P for trend test < 0.001). The length of hospital stay (P for trend = 0.002) was longer, and all-cause mortality at 30 days (P for trend = 0.008) and 90 days (P for trend = 0.001) was higher across the restrictive spirometric pattern severity. In multivariable-adjusted analyses, a moderate-to-severe restrictive spirometric pattern was associated with a higher risk of PPCs compared with a normal spirometric pattern (adjusted odds ratio 2.64, 95% confidence interval 1.22–5.67). The incidence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with a normal spirometric pattern, especially in patients with a moderate-to-severe restrictive spirometric pattern. Patients with a moderate-to-severe restrictive spirometric pattern should be regarded as high risk for developing PPCs following non-cardiothoracic surgery.
Highlights
Pulmonary complications are a major cause of morbidity and mortality following adverse perioperative events in patients undergoing non-cardiothoracic surgery[1,2,3,4,5]
It is known that a restrictive spirometric pattern is associated with a multitude of clinical conditions beyond the lungs and thorax; these include aging[8,9], smoking[10], obesity, metabolic syndrome, diabetes mellitus[11,12,13,14], and cardiovascular diseases[15,16,17,18], some of which may increase the risk of pulmonary complications (PPCs) following non-cardiothoracic surgery[1,2,3,4,5]
We found that the incidence of PPCs in patients with a restrictive spirometric pattern was higher than that of patients with normal spirometry, and this was most evident in patients with a moderate-to-severe restrictive spirometric pattern
Summary
Pulmonary complications are a major cause of morbidity and mortality following adverse perioperative events in patients undergoing non-cardiothoracic surgery[1,2,3,4,5]. With recent advances in anesthetic and surgical techniques and improved perioperative care, patients who were previously ineligible are able to undergo many types of operations. To meet their medical needs, respiratory physicians perform in-depth consultations to evaluate the risk of postoperative pulmonary complications (PPCs) and to determine optimal perioperative management. Given that chronic obstructive pulmonary disease (COPD) is the leading cause of PPCs, most previous studies have focused on the relationship between airflow limitation and the occurrence of PPCs following non-cardiothoracic surgery[1,3,4,5,19,20]. The objective of the present study was to evaluate the incidence of PPCs in adult patients with a restrictive spirometric pattern who underwent non-cardiothoracic surgery and the association between the severity of the restrictive spirometric pattern and the occurrence of PPCs following non-cardiothoracic surgery
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