Development of a scoring system to predict postoperative pulmonary complications in a tertiary care center

Abstract

Objective: There is no existing scoring system to predict postoperative risks, such as the Canet scoring system, for patients referred to pulmonology clinics.The aim of this study was to develop a scoring system to predict postoperative pulmonary complications (PPCs) in patients referred to the pulmonology clinics for preoperative evaluation. Patients ans Methods: This prospective, single-center study included patients referred for preoperative evaluation by surgical departments to the pulmonary medicine clinic at a tertiary care center. Preoperative demographic data and pulmonary evaluation results were recorded. Patients were followed postoperatively until discharge, with follow-up phone calls at the first month to assess pulmonary symptoms. Mortality data was recorded at the third month. Results: A total of 203 patients were included between January 2018 and February 2020. Of these, 55.7% were female, with a mean age of 60.59 years. PPC rate at the first month was 36.4%, and 22.7% had ongoing symptoms or new complications. The most common complication was bronchospasm (23.2%). Significant preoperative risk factors included surgery type, preoperative cough/dyspnea, and the season of surgery (p<0.05). Pulmonary complications were three times more frequent in patients undergoing upper abdominal or thoracic surgery. Conclusion: Avoiding surgery during symptomatic periods and making optimal preoperative preparations may reduce the PPC rates.

Keywords

• Preoperative pulmonary evaluation
• Postoperative pulmonary complication
• Canet risk scoring

References

1. Mitchell CK, Smoger SH, Pfeifer MP, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 1998;133:194-8.doi: 10.1001/archsurg.133.2.194.
2. Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999;115:58S-63S.doi: 10.1378/chest.115.suppl_2.58S.
3. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997;111: 564-71.doi: 10.1378/chest.111.3.564
4. Türk Toraks Derneği Preoperatif Uzlaşı Raporu. 2024. https://toraks.org.tr/site/sf/books/2024/10/8facb51b01e0786 bc1bfd711d114fbdbc30658f657f88212066ba7d9ab598db0. pdf (Access date: 23.01.2025)
5. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50. doi: 10.1097/ ALN.0b013e3181fc6e0a.
6. Malhotra RK, Indrayan A. A simple nomogram for sample size for estimating sensitivity and specificity of medical tests. Indian J Ophthalmol2010;58:519-22. doi: 10.4103/0301- 4738.71699.
7. Song YY, Ying L. Decision tree methods: applications for classification and prediction. Shanghai Arch Psychiatry2015;27:130. doi: 10.11919/j.issn.1002- 0829.215044.
8. Arozullah A, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg2000;232:242-53. doi: 10.1097/00000.658.200008000- 00015.

9. Hua M, Brady JE, Li G. A scoring system to predict unplanned intubation in patients having undergone major surgical procedures. Anesth Analg 2012;115:88-94. doi: 10.1213/ ANE.0b013e318257012b.
10. Kor DJ, Warner DO, Alsara A, et al. Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology 2011;115:117.doi: 10.1097/ ALN.0b013e31821b5839
11. Ramachandran SK, Nafiu OO, Ghaferi A, Tremper KK, Shanks A, Kheterpal S. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Surv Anesthesiol 2012;56:137-8. doi: 10.1097/ALN.0b013e31821cf6de.
12. Blum JM, Stentz MJ, Dechert R, et al. Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Surv Anesthesiol2013;57:308-9. doi: 10.1097/ ALN.0b013e318.279.4975.
13. Brueckmann B, Villa-Uribe JL, Bateman BT, et al. Development and validation of a score for prediction of postoperative respiratory complications. Surv Anesthesiol2013;57:309. doi: 10.1097/ALN.0b013e318293065c.
14. Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. Am J Med2002;112:219-25. doi: 10.1016/ s0002-9343(01)01082-8.
15. Silvanus MT, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology2004;100:1052-7. doi: 10.1097/00000.542.200405000-00004.
16. Hong CM, Galvagno SM Jr. Patients with chronic pulmonary disease. Med Clin North Am2013;97:1095-107. doi: 10.1016/j. mcna.2013.06.001.
17. Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest 1996;110:744-50. doi: 10.1378/chest.110.3.744.
18. Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 2014;121:219-31. doi: 10.1097/ ALN.000.000.0000000334.
19. Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998;113:883-9. doi: 10.1378/chest.113.4.883.
20. Theadom A, Cropley M. Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review. Tob Control 2006;15:352-8. doi: 10.1136/ tc.2005.015263.
21. Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989;64:609-16. doi: 10.1016/ s0025-6196(12)65337-3.
22. Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 2011;212:187-94. doi: 10.1016/j.jamcollsurg.2010.09.013.
23. Hare GM, Baker JE, Pavenski K. Assessment and treatment of preoperative anemia: Continuing Professional Development. Can J Anaesth 2011;58:569-81. English, French. doi: 10.1007/ s12630.011.9498-2.
24. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middleaged men and women. Sleep 1997;20:705-6. doi: 10.1093/ sleep/20.9.705.
25. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999;340:937-44.doi: 10.1056/NEJM199.903.253401207.
26. Miller MR, Crapo R, Hankinson J, et al. ATS/ERS Task Force. General considerations for lung function testing. Eur Respir J 2005;26:153-61. doi: 10.1183/09031936.05.00034505.
27. Joo HS, Wong J, Naik VN, Savoldelli GL. The value of screening preoperative chest x-rays: a systematic review. Can J Anaesth 2005;52:568-74. doi: 10.1007/BF03015764.
28. Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986 ;133:14-20. doi: 10.1164/arrd.1986.133.1.14.
29. Olsson G. Bronchospasm during anaesthesia. A computeraided incidence study of 136,929 patients. Acta Anaesthesiol Scand 1987;31:244-52.doi: 10.1111/j.1399-6576.1987. tb02560.x.
30. Wightman J. A prospective survey of the incidence of postoperative pulmonary complications. J Br Surg 1968;55:85- 91.doi: 10.1002/bjs.180.055.0202.
31. Eichenberger A, Proietti S, Wicky S,et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002;95:1788-92. doi: 10.1097/00000.539.200212000-00060.
32. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144:581-95.doi: 10.7326/0003-4819- 144-8-200604.180.00009.
33. LaPar DJ, Nagji AS, Bhamidipati CM, et al. Seasonal variation influences outcomes following lung cancer resections. Eur J Cardiothorac Surg 2011;40:83-90. doi: 10.1016/j. ejcts.2010.11.023.
34. Hu Q, Shi L, Chen L, et al. Seasonality in the adverse outcomes in weight loss surgeries. SurgObesRelatDis2018;14:291-6.doi: 10.1016/j.soard.2017.11.029.