Abstract
BackgroundPostoperative pulmonary complications (PPC) in patients with pulmonary diseases remain to be resolved clinical issue. However, most evidence regarding PPC has been established more than 10 years ago. Therefore, it is necessary to evaluate perioperative management using new inhalant drugs in patients with obstructive pulmonary diseases.MethodsApril 2014 through March 2015, 346 adult patients with pulmonary diseases (257 asthma, 89 chronic obstructive pulmonary disease (COPD)) underwent non-pulmonary surgery except cataract surgery in our university hospital. To analyze the risk factors for PPC, we retrospectively evaluated physiological backgrounds, surgical factors and perioperative specific treatment for asthma and COPD.ResultsFinally, 29 patients with pulmonary diseases (22 asthma, 7 COPD) had PPC. In patients with asthma, smoking index (≥ 20 pack-years), peripheral blood eosinophil count (≥ 200/mm3) and severity (Global INitiative for Asthma(GINA) STEP ≥ 3) were significantly associated with PPC in the multivariate logistic regression analysis [odds ratio (95% confidence interval) = 5.4(1.4–20.8), 0.31 (0.11–0.84) and 3.2 (1.04–9.9), respectively]. In patients with COPD, age, introducing treatment for COPD, upper abdominal surgery and operation time (≥ 5 h) were significantly associated with PPC [1.18 (1.00–1.40), 0.09 (0.01–0.81), 21.2 (1.3–349) and 9.5 (1.2–77.4), respectively].ConclusionsHistory of smoking or severe asthma is a risk factor of PPC in patients with asthma, and age, upper abdominal surgery, or long operation time is a risk factor of PPC in patients with COPD. Adequate inhaled corticosteroids treatment in patients with eosinophilic asthma and introducing treatment for COPD in patients with COPD could reduce PPCs.
Highlights
Postoperative pulmonary complications (PPC) in patients with pulmonary diseases remain to be resolved clinical issue
Most evidence regarding the risk factors for PPC was established more than 10 years ago, and recent advances in inhalant drugs have changed the clinical course in affected patients, especially those with asthma and chronic obstructive pulmonary disease (COPD)
The merit of using laparoscopic surgery to reduce the risk of PPC was masked by its intrinsically longer operation time. In addition to these risk factors, in the present study, we provide the newly evidence demonstrating that introducing treatment for COPD, including long-acting muscarinic antagonist (LAMA) and longacting beta agonist (LABA), reduced the risk of PPC
Summary
Postoperative pulmonary complications (PPC) in patients with pulmonary diseases remain to be resolved clinical issue. It is necessary to evaluate perioperative management using new inhalant drugs in patients with obstructive pulmonary diseases. Postoperative pulmonary complications (PPCs) and their management are clinically important in patients with asthma and chronic obstructive pulmonary disease (COPD). All surgical patients with an abnormal pulmonary function test undergo a medical examination performed by pulmonologists and are administered medical treatment and evaluated for risk factors for PPC development. Most evidence regarding the risk factors for PPC was established more than 10 years ago, and recent advances in inhalant drugs have changed the clinical course in affected patients, especially those with asthma and COPD.
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