Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar

Abstract

Abstract Purpose:Postoperative pulmonary complications (PPCs) are a majör cause of mortality and morbidity.Aim of the study to evaluate frequencies and determine risk factors of PPCs which developed subsequent to general surgery and orthopedic surgery in a tertiary university hospital. Materials- Methods:Patients who were operated in Departments of General Surgery and Orthopedics and Traumatology were retrospectively included to the study. Results: 683 patients with a mean age of 59.43 ± 18.77 years were included in the study. The ratio of PPC was 10.3%. Most frequent PPC was found to be pneumonia ( 6.3%).The prevelance of PPC was significantly higher in patients ≥ 65 years than who were <65 years old (18.2% vs 4.4%) (p<0.001). PPC was more frequent in patients who undergone urgent surgery than those who undergone elective surgery (24.1% vs 8%) (p<0.001).The rates of development of PPC according to the duration of opera-tion (30 min-1 h, 1-2 h, 2-3 h, 3-4 h, >4 h ) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regression analysis showed that being ≥ 65 years, having ASA≥3 and hypoalbuminemia (<3g/dl) were independent risk factors for development of PPC [OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05; OR:6.4, 95% CI (3.14-13.1) p<0.05]. Conclusion: The clinicians should be aware of PPCs especially in patients who were ≥ 65 years, had ASA≥3 and hypoalbuminemia (<3g/dl). Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar Özet Amaç:Postoperatif pulmoner komplikasyonlar (PPK) önemli mortalite ve morbidite sebebidir. Çalışmamızın amacı ortopedi ve genel cerrahi operasyonlarından sonra gelişen PPK sıklığını ve risk faktörlerini belirlemektir. Gereç ve Yöntem:Genel cerrahi, ortopedi ve travmatoloji kliniklerinde opere edilen haslar retrospektif olarak değerlendirildi. Bulgular: Ortalama yaşı 59.43±18.77 yıl olan 683 hasta çalışmaya alındı.PPK %10.3 idi. Pnömöni (%6.3) en sık görülen PPK olarak tespit edildi.PPK sıklığı 65 yaş ve üs-tünde altında göre belirgin olarak yüksek saptandı. (18.2% vs 4.4%) (p<0.001).Acil cerrahi operasyonlarda elektif operasyonlara göre daha sık tespit edildi (24.1% vs 8%) (p<0.001).Operasyon süresinine göre (30 dk-1 st,1-2 st,2-3 st,4 st, >4st) PPK gelişim oranı sırasıyla %2.8,%9.5,%25,%75 ve %100 olarak bulundu (p<0.001). Çok değiş-kenli logiistik regresyon analizine göre ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üstü PPK gelişiminde bağımsız risk faktörü olarak saptandı [OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05; OR:6.4, 95% CI (3.14-13.1) p<0.05]. Sonuç:ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üzerinde klinisyenler PPK açısından dikkatli olmalıdır.

Keywords

• PPK
• cerrahi
• mortalite

Postoperative pulmonary complications in noncardiothoracic surgery

Abstract

Purpose: Postoperative pulmonary complications (PPCs) are a major cause of mortality and morbidity. The
aim of this study is to evaluate frequencies and determine risk factors of PPCs which developed subsequent to
general surgery and orthopedic surgery in a tertiary university hospital.
Materials-methods: Patients who were operated in Departments of General Surgery and Orthopedics and
Traumatology were retrospectively included to the study.
Results: 683 patients with a mean age of 59.43±18.77 years were included in the study. The ratio of PPC was
10.3%. Most frequent PPC was found to be pneumonia (6.3%). The prevelance of PPC was significantly higher
in patients ≥65 years than who were <65 years old (18.2% vs 4.4%) (p<0.001). PPC was more frequent in
patients who undergone urgent surgery than those who undergone elective surgery (24.1% vs 8%) (p<0.001).
The rates of development of PPC according to the duration of operation (30 min-1 h, 1-2 h, 2-3 h, 3-4 h, >4
h) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regression
analysis showed that being ≥65 years, having ASA≥3 and hypoalbuminemia (<3g/dl) were independent risk
factors for development of PPC (OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05;
OR:6.4, 95% CI (3.14-13.1) p<0.05).
Conclusion: The clinicians should be aware of PPCs especially in patients who were ≥65 years, had ASA≥3
and hypoalbuminemia (<3g/dl).

Keywords

• PPCs
• surgery
• mortality

References

1. References: Reference 1.Günlüoğlu Z.Postoperative pulmonary complications.JCAM 2010;516:109-115. Reference 2. Davies OJ, Husain T, Stephens RCM. Postoperative pulmonary complications following non-cardiothoracic surgery. BJA Education 2017; 17 (9): 295–300 Reference 3. A Taylor, Z DeBoard, JM Gauvin, Prevention of postoperative pulmonary Surg Clin North Am 2015; 95:237-254. Reference 4. ASA Physical Status Classification System, Developed By: ASA House of Delegates/Executive Committee Last Amended: October 15, 2014 (original approval: October 15, 2014) accesed online on December 2018, available at https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system Reference 5.Özdilekcan Ç, Songur N, Berktaş BM, Dinç M, Üçgül E, OK U.Risk factors associated with postoperative pulmonary complications following oncological surgery. Tuberculosis and thorax 2004; 52(3): 248-255. Reference 6. Kozower BD, Sheng S, O’Brien SM, Liptay MJ, Lau CL, Jones DR. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg. 2010 ;90(3):875-81. Reference 7. Saracoğlu A, Yavru A , Kucukgoncu S, Tuzuner F, Karadeniz M, Başaran B, et al. Predictive Factors Involved in Development of Postoperative Pulmonary Complications Turk J Anaesth Reanim 2014; 42: 313-9. Reference 8. Annakkaya A, Tozkoparan E, Deniz Ö, Bedirhan İ, Bilgiç H, Ekiz K, et al.Postoperative Pulmonary Complications.Toraks Dergisi 2005: 6(2):104-8. Reference 9. Arozullah AM, Khuri SF, Henderson WG, Daley J. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery.Ann Intern Med. 2001;135(10):847-57. Reference 10.Matsuoka Y, Morimatsu H. Incidence Rates of Postoperative Pulmonary Embolisms in Symptomatic and Asymptomatic Patients, Detected by Diagnostic Images ,A Single-Center Retrospective Study .Circ J 2019; 83: 432–440. Reference 11.Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010 Dec;113(6):1338-50. Reference 12.Smetana GW, Lawrence VA, Cornell JE; American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.Ann Intern Med. 2006 Apr 18;144(8):581-95. Reference 13. Li C, Yang WH, Zhou J, Wu Y, Li YS, Wen SH, et al. Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: results from a single vascular center in China. J Clin Anesth 2013; 25: 371–8 Reference 14. Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia 2017; 118 (3): 317–34. Reference 15. Øberg B, T. D. Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand 1996;40(2):191-200. Reference 16. Dindo D, Muller MK, Weber M,Clavie PA. Obesity in general elective surgery. Lancet. 2003;361(9374):2032-5. Reference 17.Gronkjaer M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, et al. Preoperative smoking status and Postoperative complications: A systematic review and metaanalysis. Ann Surgery 2014;259 (1):52-71. Reference 18.Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575-80. Reference 19. Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy.Chest 1991;99:923-7. Reference 20.Hollmann MW, Wieczorek KS, Smart M, Durieux ME. Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery. Reg Anesth Pain Med. 2001 May-Jun;26(3):215-22. Reference 21. Pedersen T, Viby-Mogensen J, Ringsted J. Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand 1992;36(8):812-8. Reference 22. Kocabas A, Kara K, Ozgur G, Sonmez H, Burgut R. Value of preoperative spirometry to predict postoperative pulmonary complications.Respir Med. 1996;90(1):25-33. Reference 23. Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients. 2017 Aug; 9(8): 829. Reference 24.Karas PL, Goh SL, Dhital K. Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery? Interact CardioVasc Thorac Surg 2015;21:777–86. Reference 25. Hardt, J, Pilz L, Magdeburg J, Kienle P, Post S, Magdeburg, R. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. International Journal of Colorectal Disease 2017; 32(10): 1439–46. Reference 26. Li P, Li J, Lai Y, Wang Y, Wang X, Su J, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study. J Thorac Dis 2018;10(10):5755-63 Reference 27. Ryan AM, Hearty A, Prichard RS , Cunningham A, Rowley SP, Reynolds JV. Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy J Gastrointest Surg 2007;11(10):1355–60. Reference 28. Kim S, McClave SA, Martindale RG, Miller KR, Hurt RT.Hypoalbuminemia and Clinical Outcomes: What is the Mechanism behind the Relationship? Am Surg. 2017;83(11):1220-27.