Risk Factors For Postoperative Pulmonary Complications Research Articles

PPCRKB: a risk factor knowledge base of postoperative pulmonary complications.

Postoperative pulmonary complications (PPCs) are highly heterogeneous disorders with diverse risk factors frequently occurring after surgical interventions, resulting in significant financial burdens, prolonged hospitalization and elevated mortality rates. Despite the existence of multiple studies on PPCs, a comprehensive knowledge base that can effectively integrate and visualize the diverse risk factors associated with PPCs is currently lacking. This study aims to develop an online knowledge platform on risk factors for PPCs (Postoperative Pulmonary Complications Risk Factor Knowledge Base, PPCRKB) that categorizes and presents the risk and protective factors associated with PPCs, as well as to facilitate the development of individualized prevention and management strategies for PPCs based on the needs of each investigator. The PPCRKB is a novel knowledge base that encompasses all investigated potential risk factors linked to PPCs, offering users a web-based platform to access these risk factors. The PPCRKB contains 2673 entries, 915 risk factors that have been categorized into 11 distinct groups. These categories include habit and behavior, surgical factors, anesthetic factors, auxiliary examination, environmental factors, clinical status, medicines and treatment, demographic characteristics, psychosocial factors, genetic factors and miscellaneous factors. The PPCRKB holds significant value for PPC research. The inclusion of both quantitative and qualitative data in the PPCRKB enhances the ability to uncover new insights and solutions related to PPCs. It could provide clinicians with a more comprehensive perspective on research related to PPCs in future. Database URL: http://sysbio.org.cn/PPCs.

Nursing Care in Prevention of Post-Operative Pulmonary Complications among High-Risk Hospitalized Patients: A Case Study Design

Introduction: Post-operative pulmonary complications (PPCs) such as pneumonia, atelectasis, and respiratory failure significantly impact surgical outcomes, especially among high-risk patients with pre-existing respiratory conditions, advanced age, or those undergoing major surgeries. Effective prevention of PPCs is critical for improving patient outcomes. Nursing care plays a pivotal role in this prevention through early mobilization, respiratory exercises, proper positioning, and vigilant monitoring.Objectives :This study investigates the effectiveness of nursing care in preventing PPCs among high-risk hospitalized patients.Methods: A descriptive case study design was used, involving 15 patients from a multispecialty hospital in Trivandrum who met the inclusion criteria of having more than four risk factors for PPCs and consented to participate. Data collection tools included demographic variables, clinical manifestation checklists, risk factors for PPCs, and an individualized nursing care plan. Over six weeks, patients were selected through convenience sampling and a 24-hour nursing care plan was implemented. Descriptive statistics were used for data analysis. Results: The study sample consisted predominantly of elderly patients (73.3% aged above 60 years), with males constituting 66.7%. Significant risk factors included smoking history (66.7%) and elevated BMI (53.3%). All surgeries were performed under general anesthesia, with 60% lasting over 3-4 hours. Nursing interventions included deep breathing and coughing exercises, frequent position changes, early ambulation, use of an incentive spirometer, prophylactic antibiotics, and strict aseptic techniques. Most severe PPC symptoms were absent; however, mild symptoms like elevated temperature and cough were observed in 20% of patients. Discussion: The results indicate that the comprehensive nursing care strategies effectively prevented most significant PPCs. The absence of severe symptoms suggests the success of interventions such as early mobilization and respiratory exercises. The occurrence of mild symptoms in some patients highlights the need for ongoing refinement of nursing protocols. Conclusion: Effective nursing care significantly reduces PPC incidence in high-risk postoperative patients. This study supports the development of best practice guidelines for nursing care, emphasizing individualized care plans to improve patient outcomes and ensure high-quality healthcare services.

Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry

BackgroundPreserved ratio impaired spirometry (PRISm), defined as decreased forced expiratory volume in the first second in the setting of normal ratio, is associated with an increased risk of respiratory disease and systemic comorbidities. Unlike severe obstructive pulmonary disease, little is known about the impact of PRISm on short-term outcomes in patients undergoing laparoscopic gastrectomy (LG) and its association with small airway dysfunction (SAD). MethodsThis study enrolled 830 patients who underwent preoperative spirometry and LG between January 2021 and August 2023. Of these, 228 patients were excluded. Participants were categorized into 3 groups based on their baseline lung function, and postoperative outcomes were subsequently analyzed. Potential associations between postoperative outcomes and various clinical variables were examined using univariate and multivariate analyses. ResultsPRISm was identified in 16.6% of the patients, whereas SAD was present in 20.4%. The incidence of postoperative pulmonary complications (PPCs) was notably higher in the SAD group (20.3% vs 9.8%, P = .002) and the PRISm group (28.0% vs 9.8%, P < .001) than the normal group. Among the 3 groups, pneumonia was the most frequently observed PPC. Multivariate analysis revealed that both SAD (odds ratio [OR], 2.34; 95% CI, 1.30–4.22; P = .005) and PRISm (OR, 3.26; 95% CI, 1.80–5.90; P < .001) independently constituted significant risk factors associated with the occurrence of PPCs. Univariate analysis showed that female was a possible risk factor for PPCs in PRISm group. ConclusionOur study showed that PRISm and SAD were associated with the increased PPCs in patients undergoing LG for gastric cancer.

Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study.

Postoperative pulmonary complications (PPCs) are among the most common complications after cardiovascular surgery. This study aimed to explore the real incidence of and risk factors for PPC in patients with acute type A aortic dissection (ATAAD) who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR + FET). In total, 305 ATAAD patients undergoing TAR + FET from January 2021 to August 2022 in a single-center were divided into PPCs or non-PPCs group. The incidence of PPCs was calculated, risk factors of PPCs were analyzed, and postoperative outcomes were compared between these 2 groups. The incidence of any PPC was 29.2%. And the incidence of respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, acute respiratory distress syndrome, aspiration pneumonitis, pulmonary edema and bronchospasm was 23.0%, 12.5%, 10.5%, 1.0%, 0.7%, 1.0%, 0%, 0.7%, 0%, respectively. The logistic regression analysis revealed that the history of diabetes, history of renal dysfunction, preoperative SpO2 <90%, cardiopulmonary bypass duration, fresh frozen plasma volume and platelet concentrates volume were independent risk factors for PPCs. Among 2 groups, postoperative ventilation duration, postoperative length of stay in intensive care unit and hospital were (73.5 ± 79.0 vs 24.8 ± 35.2 hours; P < .001), (228.3 ± 151.2 vs 95.2 ± 72.0 hours; P < .001) and (17.9 ± 8.8 vs 11.5 ± 6.2 days; P < .001). There was no difference between 2 groups of in-hospital mortality rate. Additionally, other short-term outcomes were also significantly poorer in patients with PPCs. PPCs are common in ATAAD patients undergoing TAR + FET, and could be multifactorial. PPCs occurrence are associated with poor patient outcomes postoperatively and worth further investigation.

Association of preoperative frailty with pulmonary complications after cardiac surgery in elderly individuals: a prospective cohort study.

The relationship between preoperative frailty and pulmonary complications after cardiac surgery in elderly patients is unclear. This study was designed to evaluate the relationship between frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing cardiac surgery and to provide a basis for their prevention and treatment. This study aimed to investigate the predictive value of preoperative frailty on pulmonary complications after cardiac surgery in elderly patients. Frailty was assessed using the CAF. The diagnosis of PPCs was based on the criteria defined by Hulzebos et al., and patients were classified into a PPCs group and a non-PPCs group. Factors with clinical significance and P < 0.05 in univariate regression analysis were included in multivariate logistic regression analysis to determine the relationship between preoperative frailty and PPCs. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the predictive effects of the CAF, EuroSCORE II, and ASA + age on the occurrence of PPCs. A total of 205 patients were enrolled in this study, 31.7% of whom developed PPCs. Univariate logistic regression analysis showed that frailty, ASA grade, EuroSCORE II, hemoglobin concentration, FVC, time of operation, and postoperative AKI were associated with the development of PPCs. However, after adjustments for all possible confounding factors, multivariate logistic regression results showed that frailty, prolonged operation time, and postoperative AKI were risk factors for PPCs, and the risk of postoperative PPCs in frail patients was approximately 4.37 times that in nonfrail patients (OR = 4.37, 95%CI: 1.6-11.94, P < 0.05). The predictive efficacy of the traditional perioperative risk assessment tools EuroSCORE II and ASA + age was lower than that of CAF. Frailty before surgery, prolonged operation time, and postoperative AKI were independent risk factors for pulmonary complications after heart surgery in elderly individuals, and CAF was more effective than the traditional risk predictors EuroSCORE II and ASA + age.

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass.

This retrospective study was designed to evaluate preoperative pulmonary function test (PFT) results and skeletal muscle mass, represented by the erector spinae muscle (EM), as predictors of postoperative pulmonary complications (PPCs) in older patients undergoing lobectomy for lung cancer. The medical records, including preoperative PFT, chest computed tomography (CT) and PPCs, of patients older than 65 years undergoing lobectomy for lung cancer were retrospectively examined at Konkuk University Medical Center from January 2016 to December 2021. The sum of cross-sectional areas (CSAs) of the right and left EMs at the level of the spinous process with the 12th thoracic vertebra was used as the skeletal muscle mass (CSABoth). Data from a total of 197 patients were included in the analyses. In total, 55 patients had PPCs. The preoperative functional vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) showed significantly poorer values and the CSABoth had significantly lower values in patients with than in those without PPCs. The preoperative FVC and FEV1 showed significant positive correlations with CSABoth. Multiple logistic regression analysis identified age, diabetes mellitus (DM), preoperative FVC and CSABoth as risk factors for PPCs. The areas under the curves for FVC and CSABoth were 0.727 (95% CI, 0.650-0.803; P<0.001) and 0.685 (95% CI, 0.608-0.762; P<0.001), respectively. The optimal threshold values of FVC and CSABoth to predict PPCs based on a receiver operating characteristic curve analysis were 2.685 L (sensitivity =64.1% and specificity =61.8%) and 28.47 mm2 (sensitivity =62.0% and specificity =61.5%), respectively. PPCs in older patients undergoing lobectomy for lung cancer were associated with lower preoperative FVC and FEV1 values and a lower skeletal muscle mass. Skeletal muscle mass, represented by the EM, was significantly correlated with the preoperative FVC and FEV1. Therefore, skeletal muscle mass may be useful for the prediction of PPCs in patients undergoing lobectomy for lung cancer.

Impact of sarcopenia on postoperative pulmonary complications after gastric cancer surgery: A retrospective cohort study.

Few studies have investigated the relationship between sarcopenia and postoperative pulmonary complications (PPCs) after gastric cancer surgery. This study aimed to explore the impact of sarcopenia on PPCs in patients who had undergone gastric cancer surgery. We included patients who underwent a transabdominal radical gastrectomy between June 2016 and October 2020. Patients were divided into two groups according to the median prevalence rate of lumbar triplane skeletal muscle index (L3 SMI): sarcopenia group (≤37.5% percentile in male and female group) and non-sarcopenia group (>37.5% percentile in male and female group). Baseline characteristics, intraoperative and postoperative conditions, pulmonary complications, and overall complications were compared between the two groups. The primary outcome was the incidence of PPCs. The secondary outcomes were overall postoperative complications and length of stay (LOS). Among the 143 patients included, 50 had sarcopenia and 93 had not. Compared to the non-sarcopenia group, the sarcopenia group had a higher the incidence of PPCs (22.0% vs. 8.6%, P = 0.024). The incidence of overall postoperative complications in the sarcopenia group was higher than that in the non-sarcopenia group (36.00% vs. 20.43%, P = 0.043). There was no significant difference in the LOS between the two groups. Our research indicates that sarcopenia, preoperative comorbidities, and longer duration of intraoperative oxygen saturation <95% were risk factors for PPCs. Sarcopenia is an independent risk factor for postoperative complications. Given that our results provided a correlation rather than causation, future prospective randomized trials are needed to confirm the relationship between sarcopenia and prognosis.

Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: a propensity-matched analysis

ObjectivesTo assess the prevalence of postoperative pulmonary complications (PPCs), the perioperative factors associated with PPCs, and the association of PPCs with postoperative outcomes in ovarian cancer patients undergoing cytoreductive surgery.MethodsA retrospective analysis was conducted on patients who underwent cytoreductive surgery in our hospital, between September 2017 and January 2021, and patient medical records were reviewed to collect relevant clinical information. Univariable and multivariable analyses were used to identify significant risk factors for PPCs. Analysis of the association of PPCs with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and multivariable logistic regression model.ResultsFinal analysis was performed with 268 ovarian cancer patients after cytoreductive surgery, among whom the incidence of PPCs was 26.9%, and the most frequent pulmonary complication was pleural effusion. According to the multivariate analysis, the intraoperative fluid infusion volume (L) (odds ratio (OR) 1.34; 95% confidence intervals (CI) 1.01–1.77; P = 0.040), diameter size of diaphragmatic resection (cm) (OR 1.16; 95% CI 1.06–1.28; P = 0.002), and surgical complexity scores (OR 1.26; 95% CI 1.13–1.42; P < 0.001) were significantly associated with the development of PPCs. The multivariable logistic regression analyses with propensity-matched controls demonstrated that the occurrence of PPCs significantly increased the risk of 30-day readmission (OR 6.01; 95% CI 1.12–32.40; P = 0.037) and did not significantly affect inpatient mortality.ConclusionOvarian cancer patients undergoing cytoreductive surgery, especially those with diaphragmatic resection or higher surgical complexity scores, represent a high-risk population for PPCs. In addition, goal-directed fluid therapy is vital to reducing the occurrence of PPCs in patients at risk. PPCs were not associated with in-hospital mortality but were significantly associated with an increased risk of 30-day readmission after cytoreductive surgery.

Choice of neuromuscular block reversal agent to reduce postoperative pulmonary complications.

The definition of postoperative pulmonary complications (PPCs) is inconsistent in literature; however, PPCs include pulmonary abnormalities that adversely affect patient outcomes, such as respiratory failure, atelectasis, pneumonia, pleural effusion, and exacerbation of underlying lung conditions. Furthermore, although the incidence of PPCs varies according to its definition, surgery type, and patient population, they can lead to increased morbidity, mortality, duration of hospitalization, and medical costs; thus, efforts to identify and reduce the risk factors are important to improve patient outcomes. Among the risk factors for PPCs, residual neuromuscular block is a representative and preventable anesthesia-related risk factor that is affected by the choice of the reversal agent. However, it is not clear whether the chosen reversal agent, i.e., sugammadex, reduces PPCs better when compared to anticholinesterases. Additionally, the effects of the reversal agents on PPCs in high-risk patients, such as elderly patients, pediatric patients, those with end-stage renal disease, obesity, obstructive sleep apnea, or those undergoing specific surgeries, are diverse. To reduce the PPCs associated with the use of neuromuscular blocking agents, it is important to confirm complete reversal of the neuromuscular block under neuromuscular monitoring. Additionally, efforts to reduce the incidence of PPCs through interdisciplinary communication are required.

Using Nomograms to Predict the PPCs of Patients With Diffuse Peritonitis Undergoing Emergency Gastrointestinal Surgery.

Objective: To develop and validate a nomogram model for predicting postoperative pulmonary complications (PPCs) in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery.Methods: We used the least absolute shrinkage and selection operator (LASSO) regression model to analyze the independent risk factors for PPCs in patients with diffuse peritonitis who underwent emergency gastrointestinal surgery. Using R, we developed and validated a nomogram model for predicting PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery.Results: The LASSO regression analysis showed that AGE, American Society of Anesthesiologists physical status classification (ASA), DIAGNOSIS, platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN were independent risk factors for PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery. The area under the curve (AUC) value of the nomogram model in the training group was 0.8240; its accuracy was 0.7000, and its sensitivity was 0.8658. This demonstrates that the nomogram has a high prediction value. Also in the test group, the AUC value of the model established by the variables AGE, ASA, and platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN was 0.8240; its accuracy was 0.8000; and its specificity was 0.8986. In the validation group, the same results were obtained. The results of the clinical decision curve show that the benefit rate was also high.Conclusion: Based on the risk factors AGE, ASA, DIAGNOSIS, platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN, the nomogram model established in this study for predicting PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery has high accuracy and discrimination.

Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital

BackgroundThe incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais.MethodsA retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores.ResultsIn all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001).ConclusionsPPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.

Identification of the Risk Factors of Postoperative Pulmonary Complications in Elderly Patients Undergoing Elective Colorectal Surgery.

This study was to identify the perioperative related risk factors of postoperative pulmonary complications (PPCs) in elderly patients undergoing elective colorectal surgery, which will provide new insight for better prevention and intervention of PPCs in elderly patients. A retrospective study involving 445 patients (age ≥65), who registered in Shengjing Hospital affiliated to China Medical University for elective colorectal surgery from October 2014 to March 2017, was conducted. Clinical data, including demographic information, medical history, preoperative examination, and surgery-related factors, were analyzed and compared between the patient group with PPCs and the group without PPCs. t-test or χ2 test was performed for statistical analysis between the 2 groups. Binary logistic regression analysis was further employed to identify the potential independent risk factors of PPCs. Among the 445 patients enrolled in the study, 49 (11%) had PPCs, while 396 (89%) did not. The main risk factors of PPC occurrence in the elderly patients undergoing elective colorectal surgery included older age (age ≥75 years), ASA >II, hypertension, myocardial ischemia, basic pulmonary diseases, laparotomy, blood transfusion, preoperative hemoglobin <100 g/L, and albumin <35 g/L. Laparotomy (compared with laparoscope) and ASA >II were independent risk factors for the increased incidence of PPCs. More attention should be paid to patients with older age and ASA >II in elective colorectal surgery. Choice of laparoscopic operation, proper treatment of hypertension, myocardial ischemia, basic pulmonary diseases, and correction of anemia and nutritional status can effectively reduce the incidence of PPCs. An adequate and comprehensive evaluation of the potential risk factors related to PPCs is required before surgery.

Impact of Prognostic Nutritional Index on Postoperative Pulmonary Complications in Radical Cystectomy: A Propensity Score-Matched Analysis.

BackgroundRadical cystectomy is a standard treatment for muscle-invasive bladder cancer but frequently entails postoperative pulmonary complications (PPCs). Nutrition is closely associated with postoperative outcomes. Therefore, we evaluated the impact of preoperative prognostic nutritional index (PNI) on PPCs in radical cystectomy.MethodsPNI was calculated as 10 × (serum albumin) + 0.005 × (total lymphocyte count). The risk factors for PPCs were evaluated using multivariate logistic regression analysis. A receiver operating characteristic curve analysis of PNI was performed, and an optimal cut-off value was identified. Propensity score-matched analysis was used to determine the impact of PNI on PPCs. Postoperative outcomes were also evaluated.ResultsPPCs occurred in 112 (13.6%) of 822 patients. Multivariate logistic regression analysis identified PNI, age, and serum creatinine level as risk factors. The area under the receiver operating characteristic curve of PNI for predicting PPCs was 0.714 (optimal cut-off value: 45). After propensity score matching, the incidence of PPCs in the PNI ≤ 45 group was significantly higher compared with the PNI > 45 group (20.8% vs. 6.8%; p < 0.001), and PNI ≤ 45 was associated with a higher incidence of PPCs (odds ratio 3.308, 95% confidence interval 1.779–6.151; p < 0.001). The rates of intensive care unit admission and prolonged (> 2 days) stay thereof were higher in patients who developed PPCs.ConclusionsPreoperative PNI ≤ 45 was associated with a higher incidence of PPCs in radical cystectomy, suggesting that PNI provides useful information regarding pulmonary complications after radical cystectomy.

Incidence and Risk Factors of Pulmonary Complications after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Observational Analysis of 2208 Patients at a Large Single Center.

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.

Risk factors of postoperative pulmonary complications in patients with lung cancer surgery and intervention measures

Objective To explore the risk factors of postoperative pulmonary complications (PPC) in patients with lung cancer surgery, and to formulate intervention countermeasures to prevent PPC and reduce the risk of PPC. Methods A total of 298 cases of lung cancer patients who underwent surgical treatment from January 2013 to November 2017 were selected.General data were collected, univariate analysis was used to screen the related factors of PPC occurrence, and statistically significant variables were included in the multivariate Logistic regression model to analyze the risk factors of PPC occurrence and formulate intervention countermeasures. Results PPC occurred in 49 of 298 lung cancer patients who underwent surgery, and the the incidence was 16.44%.Elderly patients, chronic obstructive pulmonary disease(COPD), smoking, pN stage of tumor, poor respiratory exercise compliance were all independent risk factors for PPC. Conclusion The occurrence of PPC in lung cancer surgery patients is related to the elderly, COPD, smoking, pN stage of tumor and respiratory function exercise, and poor compliance.Attention should be paid to these factors, and corresponding intervention strategies should be formulated to reduce the risk of PPC and improve the prognosis of patients. Key words: Lung cancer surgery; Pulmonary complications; Risk factors

Evaluation of risk factors for postoperative pulmonary complications after elective open upper abdominal surgery in chronic obstructive pulmonary diseases patients

Background: Postoperative pulmonary complications (PPCs) range from 9% to 40% in various nonthoracic surgeries. Various risk factors are attributed for these complications. The aim of this study was to determine the risk factors for PPC in chronic obstructive pulmonary disease (COPD) patients submitted to elective open upper abdominal surgery. Materials and Methods: This was a prospective cohort study conducted in a tertiary care center after obtaining ethical committee clearance. Two hundred and twenty-nine of 427 patients planned for elective abdominal surgeries were labeled as COPD based on spirometry test. PPC and various factors affecting it were analyzed. Pre- and intra-operative data were collected and their association with the occurrence of PPC was analyzed. Relationship between PPC and other variables was tested by linear and logistic regression. Multivariate logistic regression was performed using a backward stepwise approach and accepting statistical significance at P Results: Of 229 COPD patients, 34 (14.84%) suffered PPC. The mean age was 55.76 ± 8.40 years with 78.6% being male. Patients having age >50 years and the American society of anesthesiologists IV status were more prone to developing PPC. The multivariate analysis revealed body mass index (BMI) >30 kg/m2, duration of surgery >150 min, and pCO2>45 mmHg in arterial blood gas as independent predictors of PPC. Conclusions: The present study concluded that increased pCO2, BMI, and longer duration of surgery increase PPC in COPD patients. Hence, preoperative optimization of pCO2, BMI, and a proper plan to shorten the duration surgery may reduce PPC in COPD patients undergoing open upper abdominal surgeries.

Study of post-operative pulmonary complications in patients of emergency abdominal surgeries

Background: Post-operative Pulmonary Complications (PPCs) form a significant chunk of post-operative morbidity. Their incidence varies from 2.7-23% in multiple studies. Pre-disposing factors can be divided as: pt. related: &gt;60yrs, ASA class≥2 and COPD; procedure related: long surgeries (≥3hrs), emergency surgeries. Till now, most of the studies have focused on elective surgeries. In this study, I have studied morbidity and risk factors of PPCs in emergency abdominal surgeries.Methods: It is a retrospective case control study, carried out in 50 patients in M.B. Government Hospital, Udaipur over 1 year. Cases comprised of those patients who underwent emergency laparotomy and developed PPCs. Controls were selected from group who didn’t develop PPC.Results: Incidence of PPCs in emergency abdominal surgeries was found to be 2.9%. Elderly patients had more chances of developing PPCs. Smoking was found to be twice as common in case group. Those who quit smoking ≥1 year before surgery benefitted the most. Pre-OP chest x-ray abnormalities were 3 times more common in case group. Upper abdomen surgeries were 20% more common in Case group. Surgeries lasting for ≥ 3 hours had increased chances of PPCs. Total hospital stay was 21.7 days in cases (12.5 in control), total ICU stay was 8.5 days (1.4). 28% of the PPCs patients could not be saved.Conclusions: Pre-operative chest examination, cheat x-ray and regular SpO2 monitoring helps in diagnosing PPCs earlier. Early mobilization and deep breathing exercises should be encouraged.

A nomogram prediction of postoperative pulmonary complications in patients undergoing lung cancer surgery

Objective To analyze the risk factors for postoperative pulmonary complications (PPC) in patients undergoing lung cancer surgery to establish a nomogram model to predict the risk of PPC. Methods From January 2014 to October 2017, 316 patients undergoing lung cancer surgery at Shandong Provincial Hospital Affiliated to Shandong University were enrolled in this study. Their clinical data were analyzed and univariate analysis was used to determine the risk factors related to PPC. The significant variables were included in the multivariate logistic regression analysis to analyze the independent risk factors for PPC. Then the R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the PPC. Results A total of 55 cases out of 316 patients undergoing lung cancer surgery had PPC. The prevalence rate was 17.4%. Age (OR=1.151, 95% CI 1.041-1.274), chronic obstructive pulmonary disease (COPD) (OR=3.659, 95%CI 1.498-8.939), smoking index (OR=1.171, 95% CI 1.055-1.300), pN stage (N1: OR=6.686, 95%CI 1.959-22.814; N2:OR=7.714,95%CI 2.390-24.900; N3: OR=15.943, 95%CI 4.318-58.869)and the poor compliance of breathing exercise (OR=1.298, 95%CI 1.031-1.635) were all independent risk factors for PPC. The nomogram model showed a conformance-index of 0.841, while ROC curve showed that the area under the curve for the nomogram model predicting pressure sores was 0.820 (95% CI: 0.760-0.881). Conclusions The nomogram built based on age, COPD, smoking index, pN stage, and the poor compliance of breathing exercises has good discrimination and accuracy which could be used for predicting individual PPC risk and screening the patients with high risk, with potentially high clinical application value. Key words: Lung neoplasms; Postoperative complications; Forecasting nomograms

Risk Factors for Pulmonary Complications After Laparoscopic Pylorus-preserving Pancreaticoduodenectomy: A Retrospective Observational Analysis.

Laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) is less invasive than open pylorus-preserving pancreaticoduodenectomy. However, LPPPD has a long operation time with pneumoperitoneum, which may affect the postoperative pulmonary complications (PPCs). We retrospectively evaluated the incidence of PPCs and their risk factors in LPPPD. In 191 patients who underwent LPPPD, the incidence of PPCs was 28.8% (n=55). Multivariate logistic regression analysis revealed that the risk factors for PPCs were male sex [odds ratio (OR), 2.518; P=0.008], high body mass index (OR, 1.172; P=0.024), and low preoperative serum albumin level (OR, 0.390; P=0.032). Length of hospital stay was significantly longer in the PPC group than in the no-PPC group [17 (14 to 26) vs. 14 (13 to 18) d, P<0.001]. There was no difference in the incidence of surgical complications between the PPC group and the no-PPC group (14.5% vs. 6.6%, P=0.096). These results provide useful information for perioperative pulmonary management in patients undergoing LPPPD.

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

BackgroundThe burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors.MethodsA retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present.ResultsOut of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%.ConclusionPPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.