Risk Of Postoperative Cardiopulmonary Complications Research Articles

Meta-analysis of the association between obstructive sleep apnea and postoperative complications

ObjectiveTo clarify the association between obstructive sleep apnea (OSA) and postoperative outcomes, investigate whether preoperative diagnosis and continuous positive airway pressure (CPAP) therapy reduce the risks and examine the impact of OSA severity on postoperative outcomes. MethodsThe PubMed, Cochrane Library and Embase databases were searched from inception until April 2021 for studies evaluating the association between OSA and postoperative adverse events. A random effects model was used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results. ResultsIn total, 46 studies were eligible for further analysis. OSA was significantly associated with higher risks of postoperative respiratory complications (OR = 1.91; 95% CI = 1.54 to 2.36) and cardiac complications (OR = 1.74; 95% CI = 1.25 to 2.42), and the risks increased with OSA severity. OSA also increased the risk of intensive care unit (ICU) transfer (OR = 1.92; 95% CI = 1.32 to 2.80), increased the risk of postoperative delirium (OR = 1.83; 95% CI = 1.26 to 2.66) and prolonged the length of hospital stay (WMD = 0.48; 95% CI = 0.15 to 0.82). Subgroup analysis indicated that preoperative diagnosis and use of CPAP decrease the risk of postoperative respiratory complications (OR = 1.87; 95% CI = 1.43 to 2.43) and cardiac complications (OR = 1.17; 95% CI = 0.91 to 1.51). ConclusionsPatients with OSA have a higher risk of postoperative cardiopulmonary complications, ICU transfer, delirium, pneumonia, bleeding and prolonged length of hospital stay. OSA severity is an important risk modifier for postoperative complications, preoperative diagnosis and CPAP therapy may attenuate the occurrence of postoperative complications. The conclusions need to be interpreted with caution due to the limitations in the data, despite this, the results indicate and inform the need for further and larger trials. ProsperoCRD42021254374.

Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer

The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function. This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function. The data were obtained from a prospective cohort study called Coordinate Approach to Cancer Patient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups. The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95%CI, 2.37-44.36), 5.65 (95%CI, 1.39-22.90), and 7.84 (95%CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95%CI, 1.37-17.93). Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC. ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.

Predicting postoperative cardio-pulmonary complications by a test of stair climbing.

To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Cohort study. The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge. Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed < 1 flight. All-cause cardiopulmonary complications rate was 26 %. The most frequent complication was lobar atelectasis, followed by bronchospasm and acute MI. The complication rate was 22.8% in those able to climb 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems, i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.

Size-capacity mismatch in the lung: a novel predictor for complications after lung cancer surgery

BackgroundThe aim of the present study was to make a combined pulmonary functional and anatomical assessment using spirometry and computed tomography (CT) to clarify the best predictor for cardiopulmonary complications after thoracoscopic major lung resection for cancer. MethodsWe retrospectively reviewed our prospective database of 304 patients undergoing thoracoscopic major lung resection for cancer. The total lung volume (TLV) was measured preoperatively using deep-inspiratory CT by summing the voxels representing −600 to −1024 Hounsfield units. Forced vital capacity (FVC) was measured by spirometry. FVC/TLV was used to diagnose a lung size-function mismatch. We compared among FVC/TLV, conventional spirometric parameters, and the risk of postoperative cardiopulmonary complications. ResultsPostoperative cardiopulmonary complications developed in 25 of 304 patients (8.2%). There were no cases of operative mortality. A stepwise logistic regression analysis revealed that a history of smoking and low FVC/TLV were independent risk factors for postoperative cardiopulmonary complications in various preoperative measurements. According to a receiver-operating characteristic analysis, FVC/TLV was the only variable that was statistically useful for predicting complications (area under the receiver-operating characteristic curve > 0.7). ConclusionsLung size-function mismatch was identified as the best predictor for cardiopulmonary complications after major lung resection for cancer among various spirometry- and CT-derived parameters. The usefulness of this parameter in screening for patients who are at risk of complications should be validated by a multicenter, large-scale study because it can be obtained through routine preoperative work.

Total laparoscopic pylorus-preserving pancreatoduodenectomy in an 89-year-old man: A case report and review of a single institute's experience in elderly patients.

Total laparoscopic pylorus-preserving pancreatoduodenectomy (tLPPPD) has been demonstrated to be a safe and feasible surgery for pancreatic malignant diseases located in the head or uncinate process, with the advantages including minimal invasion, lower blood loss and a shorter hospital stay, compared with traditional open pancreatoduodenonectomy. Elderly patients theoretically have a lower capability to tolerate complex surgeries. The impairment of heart and pulmonary reserve function often leads to a high risk of post-operative cardiopulmonary complications. The present study reports a case of tLPPPD that was successfully performed in an 89-year-old man. No fatal complications developed. The post-operative pathological result revealed a diagnosis of pancreatic uncinate adenocarcinoma (T2N0M0, stage IB). After 1 year of follow-up, the patient remained alive without tumor recurrence or metastasis. The present study also discusses the associated literature and concludes that tLPPPD is a safe and feasible procedure in selective elderly patients. Use of this technique may expand the number of patients who can undergo surgery and provide benefits to these patients.

Expired Gas Analysis During Exercise Testing Pre-pneumonectomy

Expired gas analysis has enabled the successful prediction of postoperative complications in patients undergoing thoracic esophagectomy. We conducted this study to determine whether preoperative expired gas analysis during exercise testing can help identify patients at high risk of postoperative complications after pneumonectomy. We measured the vital capacity, percent vital capacity, forced expiratory volume in 1.0 s, percent forced expiratory volume in 1.0 s, maximum oxygen uptake per minute, anaerobic threshold, arterial partial pressure of oxygen, and arterial partial pressure of carbon dioxide in 27 patients scheduled to undergo pneumonectomy. Group A consisted of 18 patients without postoperative cardiopulmonary complications and group B consisted of 9 patients with postoperative cardiopulmonary complications. We compared preoperative cardiopulmonary data between these two groups. Postoperative cardiopulmonary complications developed in 9 of the 27 patients (33.3%), 3 (11%) of whom died. The maximum oxygen uptake and the anaerobic threshold were significantly higher in group A than in group B (P < 0.05), whereas spirometric pulmonary function testing and arterial blood gas analysis showed no intergroup differences. Expired gas analysis during exercise testing can help identify patients at high risk of postoperative cardiopulmonary complications after pneumonectomy.

95 Retrospective review of post-operative complicationsin patients with sleep apnea syndrome undergoing same-day procedures

To clarify the association between obstructive sleep apnea (OSA) and postoperative outcomes, investigate whether preoperative diagnosis and continuous positive airway pressure (CPAP) therapy reduce the risks and examine the impact of OSA severity on postoperative outcomes.The PubMed, Cochrane Library and Embase databases were searched from inception until April 2021 for studies evaluating the association between OSA and postoperative adverse events. A random effects model was used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results.In total, 46 studies were eligible for further analysis. OSA was significantly associated with higher risks of postoperative respiratory complications (OR = 1.91; 95% CI = 1.54 to 2.36) and cardiac complications (OR = 1.74; 95% CI = 1.25 to 2.42), and the risks increased with OSA severity. OSA also increased the risk of intensive care unit (ICU) transfer (OR = 1.92; 95% CI = 1.32 to 2.80), increased the risk of postoperative delirium (OR = 1.83; 95% CI = 1.26 to 2.66) and prolonged the length of hospital stay (WMD = 0.48; 95% CI = 0.15 to 0.82). Subgroup analysis indicated that preoperative diagnosis and use of CPAP decrease the risk of postoperative respiratory complications (OR = 1.87; 95% CI = 1.43 to 2.43) and cardiac complications (OR = 1.17; 95% CI = 0.91 to 1.51).Patients with OSA have a higher risk of postoperative cardiopulmonary complications, ICU transfer, delirium, pneumonia, bleeding and prolonged length of hospital stay. OSA severity is an important risk modifier for postoperative complications, preoperative diagnosis and CPAP therapy may attenuate the occurrence of postoperative complications. The conclusions need to be interpreted with caution due to the limitations in the data, despite this, the results indicate and inform the need for further and larger trials.CRD42021254374.

An improved risk prediction method in bronchial carcinoma surgery.

In patients undergoing thoracotomy for carcinoma of the bronchus, a maximum mid-expiratory flow rate of less than 1.2 litres/sec and the operation involving right pneumonectomy have been shown to be factors associated with an increased risk of post-operative cardiopulmonary complications. These two criteria are combined with previously reported empirical limits for lung volume and ventilation values to give a new method of post-operative risk prediction. The improved method gave incorrect forecasts in only 46 of a series of 240 routinely referred patients compared with 90 by the earlier method. In a further series of the same number, only 32 patients were incorrectly forecast. The method is therefore recommended to classify patients as at either below-average, average, or above-average risk of function-related complications in future pre-operative assessments.