Uğur OK, Çiğdem ÖZDİLEKCAN, Bahadır M. BERKTAŞ, Necla SONGUR, Meral DİNÇ, Emel ÜÇGÜL

Risk factors associated with postoperative pulmonary complications following oncological surgery

Çalışmanın amacı, bir onkolojik cerrahi merkezinde farklı tiple elektif cerrahiler uygulanan hastalarda postoperatif pulmoner komplikasyonlar (PPC) 'in sıklığının saptanması ve bunlarla ilişkili risk faktörlerinin belirlenmesidir. Doksan beş erişkin hasta bir yıl süreyle prospeküf olarak çalışmaya alındı. Çalışmaya alınan grupta, pulmoner komplikasyonların belirlenmesinde yaş, cinsiyet, vücut kitle indeksi, eşlik eden akciğer hastalıkları (kronik obstrüktüf akciğer hastalığı, astım, bronşektazi, restriküf akciğer hastalığı), operasyonun yeri ve tipi, "The American Society of Anesthesiologists (ASA)" sınıflandırmasına göre fiziksel durum, fizik muayene ve akciğer grafi bulguları, solunum fonksiyon testleri, anestezi süresi ve tipi, cerrahi insizyonun yeri ve uzunluğu, operasyon sonrası nazogastrik tüp varlığı dikkate alındı. Çalışma grubunun PPC oranı %40 (38/95) olarak hesaplandı. En sık gözlenen komplikasyonlar atelektazi ve bronkospazmdı (%13.7). Çok değişkenli analizde tüm risk faktörleri içinde; abdominal insizyon (p= 0.008), anestezi süresi (p= 0.0001) ue $FEV_1$< %50 değerlerinin (p= 0.007) pulmoner komplikasyonları diğer değişkenlerden bağımsız olarak etkilediği saptandı. Diğer cerrahi girişimlere göre, çalışma grubunda pulmoner komplikasyon oranının daha yüksek olduğu görüldü. Bu sonuç, kanser hastalarına uygulanan majör rezeksiyon cerrahi seçeneklerinin varlığı ile açıklanabilmektedir. Yine de cerrahi süresinin kısaltılması ve seçilmiş hasta gruplarında genel anesteziden kaçınılmasının PPC riskini azaltacağı kanısındayız.

Onkolojik cerrahi sonrası gelişen postoperatif pulmoner komplikasyonlarla ilişkili risk faktörleri

The purpose of our study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients who have undergone various elective surgical procedures in an oncological surgery center. Ninety five adult patients were studied prospectwely for one year period. For the study group, predictors of pulmonary complications of interest were determined as age, gender, body mass index, co morbid conditions (preexisting history of chronic obtructiue pulmonary disease, asthma, bronchiectasis, restrictive lung disease), site and type of the operation, smoking history, The American Society of Anesthesiologists (ASA) physical status, physical examination and chest X- Ray findings, pulmonary function tests, type and duration of anesthesia, surgical incision site and length and presence of nasogastric tube suction. The PPC rate of our study group was 40% (38/95). Atelectasis and bronchospasm were the most frequently obserued PPCs (13.7%) Among all the risk factors taken into consideration, only three were found to be significant independent predictors of pulmonary complications according to multiuariate analysis as follows: incision location concerning abdomen (p= 0.008), duration of anesthesia per hour (p= 0.0001), values of $FEV_1$ < 50% (p= 0.007). Our data repealed that the incidence of PPCs was high in our study group when compared to results of general population. Application of major resection surgeries for cancer patients can be an explanation for this result. Shortening the duration of surgery, auoiding general aneasthesia in selected group of patients may reduce the risk of PPCs.

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