Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

Autor: Jae-Woo Lee, Ricardo Martinez Ruiz, Gyorgy Frendl, Megan M. Colwell, Bala Subramaniam, Angela Moss, Marcos F. Vidal Melo, Nitin Mehdiratta, Ana Fernandez-Bustamante, Karsten Bartels, Juraj Sprung, Jadelis Giquel, William G. Henderson, Kerstin Kolodzie, Daryl J. Kor
Rok vydání: 2017
Předmět:
Lung Diseases
Male
Time Factors
medicine.medical_treatment
Blood Loss
Surgical
Neurosurgical Procedures
law.invention
Postoperative Complications
0302 clinical medicine
Risk Factors
030202 anesthesiology
law
Oxygen therapy
Abdomen
Anesthesia
Orthopedic Procedures
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Aged
80 and over
education.field_of_study
Age Factors
Middle Aged
Intensive care unit
Intensive Care Units
Female
Respiratory Insufficiency
medicine.medical_specialty
Population
Preoperative care
Pelvis
03 medical and health sciences
Preoperative Care
Tidal Volume
medicine
Humans
Colloids
education
Aged
Mechanical ventilation
business.industry
Oxygen Inhalation Therapy
Odds ratio
Perioperative
Length of Stay
Respiration
Artificial
Surgery
Emergencies
business
Zdroj: JAMA Surgery. 152:157
ISSN: 2168-6254
DOI: 10.1001/jamasurg.2016.4065
Popis: Importance Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure Noncardiothoracic surgery. Main Outcomes and Measures Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67-3.89; and age [in years]: OR, 1.03, 95% CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01-1.24) factors. Conclusions and Relevance Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.
Databáze: OpenAIRE
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