Pre-operative pulmonary risk assessment in surgery patients

Yıl 2024, Cilt: 5 Sayı: 2, 135 - 143, 30.04.2024

Gülhan Albayrak Mustafa İlteriş Bardakçı Müfide Arzu Özkarafakılı

https://doi.org/10.47582/jompac.1447357

Öz

Aims: Postoperative pulmonary complications (PPC) that may develop after surgery are important causes of morbidity and mortality. PPCs cause a prolongation of hospital stays and an increase in hospitalization costs. The study aims to determine factors associated with PPCs to predict PPCs in surgical patients undergoing preoperative evaluation.
Methods: A retrospective cohort study was conducted at Şişli Hamidiye Etfal Training and Research Hospital using data from 200 patients referred for preoperative pulmonary evaluation from anesthesia and surgery clinics. This study analyzed the characteristics and outcomes of patients with PPC and those without PPC. The Canet pulmonary risk scores are used for PPC in all preoperative surgery patients. The study’s primary endpoints are to determine the development of respiratory failure,
bronchospasm/asthma, COPD exacerbation, atelectasis, pleural effusion, or pneumonia. The study also analyzed the effective respiratory function parameters for PPC development using a logistic regression model.
Results: The total study population included 200 patients with a median age of 53.5 years (aged between 19-88), 103 (51.5%) of whom were female. PPCs were observed in 38% (n=76) of the study group. There was a statistically significant difference between the patients in terms of the development of postoperative pulmonary complications according to gender (higher in males, p=0.001) and smoking (p=0.0001). Preoperative oxygen saturation (SpO2) and FEV1/FVC ratio were significant predictors of PPC development, and complications were more frequent in low-saturated patients (p=0.0001, p=0.013
respectively). The relationship between SpO2 and PPC was confirmed via logistic regression analysis. A one-unit increase in saturation reduced the occurrence of postoperative respiratory complications by 0.645-fold. The cut-off value for the saturation value was 97.5%, with a sensitivity of 46.8% and a specificity of 71.1% [p=0.0001, 95% CI, (0.521-0.798)].
Conclusion: In this study, the Canet (ARISCAT) score, a preoperative evaluation scale validated in Turkey that predicts postoperative pulmonary complications and mortality, was used. The Canet risk score is a simple risk score with moderate discriminatory performance for predicting PPCs. It may be useful in identifying individual patients at high risk of PPC and in the design of future studies to evaluate interventions to prevent these complications. However, a customized preoperative risk assessment system is needed for each patient.

Anahtar Kelimeler

Preoperative pulmonary evaluation, postoperative pulmonary complication, surgical patients, pulmonary risk, Canet (ARISCAT) scoring

Etik Beyan

Ethics committee approval was granted from our institution on 06/09/2022 with protocol number 2144

Cerrahi hastalarda preoperatif pulmonary riskin değerlendirilmesi

Öz

Giriş ve Amaç: Ameliyat sonrası gelişebilecek postoperatif pulmoner komplikasyonlar (PPK) önemli morbidite ve mortalite nedenleridir. PPC'ler hastanede kalış süresinin uzamasına ve hastanede yatış maliyetlerinin artmasına neden olur. Çalışmanın amacı, preoperatif değerlendirme için konsülte edilen hastalarda postoperatif pulmoner komplikasyonları öngörmede bir skorlama sistemi geliştirmektir. Gereç ve Yöntem: Bu araştırma kapsamında anestezi, cerrahi poliklinikleri ve diğer cerrahi kliniklerden preoperatif akciğer değerlendirmesi amacıyla konsültasyon için başvuran 200 hastanın verileri retrospektif olarak analiz edildi. Sigara içme durumu, fizik muayene bulguları, akciğer grafisi ve toraks BT bulguları, laboratuvar parametreleri, Solunum fonksiyon testi bulguları, tanı ve önerilen tedavi yaklaşımı bilgileri ile pulmoner risk skorları, postoperatif akciğer komplikasyonları, entübasyon ve yoğun bakıma yatışları değerlendirildi. Bulgular: Cinsiyete (erkeklerde daha fazla, p=0,001) ve sigara kullanımına (p=0,0001) göre hastalar arasında ameliyat sonrası akciğer komplikasyonlarının gelişimi açısından istatistiksel olarak anlamlı fark vardı. Ameliyat öncesi oksijen satürasyonu sPO2 ve FEV1/FVC oranı da PPC gelişiminin temel belirleyicileriydi ve düşük saturasyonlu kişilerde komplikasyonlar daha yüksekti (sırasıyla p=0,0001, p=0,013). sPO2 ve PPC arasındaki ilişki lojistik regresyon analizi (p=0,0001) ile doğrulandı ve PPC oluşumunun %13,6 olduğunu gösterdi. Satürasyondaki bir birimlik artış postoperatif solunum komplikasyonlarının oluşumunu 0,645 kat azalttı. Satürasyon değerinin kesme değeri %97,5, duyarlılığı %46,8 ve özgüllüğü 71,1 idi (p=0,0001). Sonuç: Bu çalışmada postoperatif pulmoner komplikasyonları öngörmek amacıyla Canet risk skorlama yöntemi kullanıldı. Bu skorlama sistemi Türkiye'de validasyonu yapılmış olup göğüs hastalıkları polikliniğine başvuran hastalarda preoperatif riskleri öngörebilecek tam kapsamlı bir skorlama sistemi mevcut değildir. Canet skorlamasının değerli bir preoperatif değerlendirme ve risk tahmini olduğu ve postoperatif pulmoner komplikasyonları ve mortaliteyi öngörmede faydalı olabileceği sonucuna varıldı.

Anahtar Kelimeler

preoperatif pulmoner değerlendirme,, postoperatif pulmoner komplikasyonlar,, cerrahi hastalar,, pulmoner risk

Etik Beyan

Kurumumuzdan 06/09/2022 tarihinde 2144 protokol numarası ile etik kurul onayı alınmıştır.

Kaynakça

• 1. Jha AK, Jha N, Malik V. Perioperative decision-making in pulmonary hypertension. Heart Lung Circ. 2023;32(4):454-466. doi: 10.1016/j.hlc.2023.01.013.
• 2. Rajagopal S, Ruetzler K, Ghadimi K, et al. Evaluation and management of pulmonary hypertension in noncardiac surgery: a scientific statement from the American Heart Association. Circulation. 2023;147(17):1317-1343. doi: 10.1161/CIR.0000000000001136.
• 3. Yoon U, Topper J, Goldhammer J. Preoperative evaluation and anesthetic management of patients with liver cirrhosis undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2022;36(5):1429-1448. doi: 10.1053/j.jvca.2020.08.022.
• 4. Machino R, Shimoyama K, Nagayasu T, Tagawa T. Preoperative inhalation therapy for patients with chronic obstructive pulmonary disease undergoing lung surgery: a retrospective study. J Cardiothorac Surg. 2022;17(1):294. doi: 10.1186/s13019-022-02042-y. PMID: 36434678.
• 5. Haines KJ, Skinner EH, Berney S, The Austin Health POST Study Investigators. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy. 2013;99(2):119-125.
• 6. D’Annoville T, D’Journo XB, Trousse D, Brioude G, Dahan L, Seitz JF. Respiratory complications after oesophagectomy for cancer do not affect disease-free survival. Eur J Cardiothorac Surg. 2012;41(5):e66-e73.
• 7. Ryu YJ, Chun EM, Shim SS, Kim JS, Kim YH. Risk factors for pulmonary complications, including pulmonary embolism, after total knee arthroplasty (TKA) in elderly Koreans. Arch Gerontol Geriatr. 2010;51(3):299-303.
• 8. Li L, Yang Q, Guo Q, Liu D, Gao H, Liu Y. Preoperative physical performance predicts pulmonary complications after coronary artery bypass grafting: a prospective study. Sci Rep. 2022;12(1):11103. doi: 10.1038/s41598-022-15145-2.
• 9. Yan T, Liang XQ, Wang T, et al. Prophylactic penehyclidine inhalation for prevention of postoperative pulmonary complications in high-risk patients: study protocol of a randomized controlled trial. Trials. 2017;18(1):571. doi: 10.1186/s13063-017-2315-7.
• 10. Su H, Zhang J, Liu Y, Peng H, Zhang L. Pre and postoperative nurse-guided incentive spirometry versus physiotherapist-guided pre and postoperative breathing exercises in patients undergoing cardiac surgery: an evaluation of postoperative complications and length of hospital stay. Medicine. 2022;101(52):e32443. doi: 10.1097/MD.0000000000032443.
• 11. Ganescu O, LaRusso K, St-Louis E, et al. The utility of echocardiography and pulmonary function testing in the preoperative evaluation of pectus excavatum. J Pediatr Surg. 2022;57(8):1561-1566. doi: 10.1016/j.jpedsurg.2021.12.010.
• 12. Petrar S, Bartlett C, Hart RD, MacDougall P. Pulmonary complications after major head and neck surgery: a retrospective cohort study. Laryngoscope. 2012;122(5):1057-1061.
• 13. Sogame LC, Vidotto MC, Jardim JR, Faresin SM. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008;109(2):222-227.
• 14. Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76(4):S60-S65.
• 15. Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH. Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC Anesthesiol. 2023;23(1):77. doi: 10.1186/s12871-023-02020-4.
• 16. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiol. 2010;113(6):1338-1350. doi: 10.1097/ALN.0b013e3181fc6e0a.
• 17. Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. J Am Soci Anesthesiologists, 2010;112(1):102-107.
• 18. Turan A, Mascha EJ, Roberman D, et al. Smoking and perioperative outcomes. Anesthesiol. 2011;114(4):837-846. doi: 10.1097/ALN.0b013e318210f560.
• 19. Grønkjær M, Eliasen M, Skov-Ettrup LS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52-71. doi: 10.1097/SLA.0b013e3182911913.
• 20. Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998;113(4):883-889. doi: 10.1378/chest.113.4.883.
• 21. Kispert J, Kazmers A, Roitman L. Preoperative spirometry predicts perioperative pulmonary complications after major vascular surgery. Am Surgeon. 1992;58(8):491-495.
• 22. Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med. 1990;88(2):101-107. doi: 10.1016/0002-9343(90)90456-n.
• 23. Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 1995;80(2):276-284. doi: 10.1097/00000539-199502000-00013.
• 24. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonaryrisk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med2006;144(8):581-595. doi: 10.7326/0003-4819-144-8-20060418000009.
• 25. Fuso L, Cisternino L, Di Napoli A, et al. Role of spirometric andarterial gas data in predicting pulmonary complications after abdominal surgery. Respir Med. 2000;94(12):1171-1176. doi:10.1053/rmed.2000.0946.
• 26. Elefterion B, Cirenei C, Kipnis E, et al. Intraoperative mechanical power and postoperative pulmonary complications in noncardiothoracic elective surgery patients: a 10-year retrospective cohort study. Anesthesiol. 2024;140(3):399-408. doi:10.1097/ALN.0000000000004848.