Esra BÜYÜK, Derya HOŞGÜN, Evrim Eylem AKPİNAR, Sümeyye ALPARSLAN BEKİR

Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar

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.

Anahtar Kelimeler:

PPK, cerrahi, mortalite

Postoperative pulmonary complications in noncardiothoracic surgery

Purpose: Postoperative pulmonary complications (PPCs) are a major cause of mortality and morbidity. Theaim of this study is to evaluate frequencies and determine risk factors of PPCs which developed subsequent togeneral surgery and orthopedic surgery in a tertiary university hospital.Materials-methods: Patients who were operated in Departments of General Surgery and Orthopedics andTraumatology 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 was10.3%. Most frequent PPC was found to be pneumonia (6.3%). The prevelance of PPC was significantly higherin patients ≥65 years than who were <65 years old (18.2% vs 4.4%) (p<0.001). PPC was more frequent inpatients 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, >4h) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regressionanalysis showed that being ≥65 years, having ASA≥3 and hypoalbuminemia (<3g/dl) were independent riskfactors 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≥3and hypoalbuminemia (<3g/dl).

Keywords:

PPCs, surgery, mortality,

PDF

___

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.