Postoperative pulmonary complications following major elective abdominal surgery: a cohort study

Kamlesh Patel, Fatemeh Hadian, Aysha Ali, Graham Broadley, Kate Evans, Claire Horder, Marianne Johnstone, Fiona Langlands, Jake Matthews, Prithish Narayan, Priya Rallon, Charlotte Roberts, Sonali Shah, Ravinder Vohra, Kamlesh Patel, Fatemeh Hadian, Aysha Ali, Graham Broadley, Kate Evans, Claire Horder, Marianne Johnstone, Fiona Langlands, Jake Matthews, Prithish Narayan, Priya Rallon, Charlotte Roberts, Sonali Shah, Ravinder Vohra

Abstract

Background: Postoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected patients undergoing major elective abdominal surgery was to determine the incidence and effects of PPC.

Methods: Data on all major elective abdominal operations performed over a 2-week period in December 2014 were collected in six hospitals. The primary outcome measure of PPC at 7 days was used. Univariate and multivariate analyses were performed to investigate how different factors were associated with PPC and the effects of such complications.

Results: Two hundred sixty-eight major elective abdominal operations were performed, and the internal validation showed that the data set was 99 % accurate. Thirty-two (11.9 %) PPC were reported at 7 days. PPC was more common in patients with a history of chronic obstructive pulmonary disease compared to those with no history (26.7 vs. 10.2 %, p < 0.001). PPC was not associated with other patient factors (e.g. age, gender, body mass index or other comorbidities), type/method of operation or postoperative analgesia. The risk of PPC appeared to increase with every additional minute of operating time independent of other factors (odds ratio 1.01 (95 % confidence intervals 1.00-1.02), p = 0.007). PPC significantly increase the length of hospital stay (10 vs. 3 days). Attendance to the emergency department within 30 days (27.3 vs. 10.6 %), 30-day readmission (21.7 vs. 9.9 %) and 30-day mortality (12.5 vs. 0.0 %) was higher in those with PPC.

Conclusions: PPC are common and have profound effects on outcomes. Strategies need to be considered to reduce PPC.

Keywords: Morbidity; Postoperative; Pulmonary complications; Surgery.

References

    1. American Thoracic Society, Infectious Diseases Society of America Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. doi: 10.1164/rccm.200405-644ST.
    1. Arozullah AM, 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 Surg. 2000;232:242–53. doi: 10.1097/00000658-200008000-00015.
    1. Banerjee D, Khair OA, Honeybourne D. Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD. Eur Respir J. 2004;23:685–91. doi: 10.1183/09031936.04.00056804.
    1. Bhangu A, Kolias AG, Pinkney T, Hall NJ, Fitzgerald JE. Surgical research collaboratives in the UK. Lancet. 2013;382(9898):1091–2. doi: 10.1016/S0140-6736(13)62013-9.
    1. Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338–50. doi: 10.1097/ALN.0b013e3181fc6e0a.
    1. Cook D, De Jonghe B, Brochard L, Brun-Buisson C. Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials. JAMA. 1998;279:781–7. doi: 10.1001/jama.279.10.781.
    1. Craven DE, Steger KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect. 1996;11:32–53.
    1. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA., Jr Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199:531–7. doi: 10.1016/j.jamcollsurg.2004.05.276.
    1. du Moulin GC, Paterson DG, Hedley-Whyte J, Lisbon A. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet. 1982;1:242–5.
    1. Ebell MH. Predicting postoperative pulmonary complications. Am Fam Physician. 2007;75:1837–8.
    1. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369(5):428–37. doi: 10.1056/NEJMoa1301082.
    1. Gazarian PK. Identifying risk factors for postoperative pulmonary complications. AORN J. 2006;84:616–25. doi: 10.1016/S0001-2092(06)63940-9.
    1. Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ, PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014;384(9942):495–503. doi: 10.1016/S0140-6736(14)60416-5.
    1. Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, et al. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth. 2007;99(4):500–8. doi: 10.1093/bja/aem211.
    1. Kazaure HS, Roman SA, Sosa JA. Association of postdischarge complications with reoperation and mortality in general surgery. Arch Surg. 2012;147:1000–7. doi: 10.1001/2013.jamasurg.114.
    1. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):89–98. doi: 10.1097/SLA.0b013e31817f2c1a.
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41.
    1. NICE. Surgical site infection. NICE quality standard 49. 2013. Available online at . Accessed 12 jan 2015.
    1. NICE. Venous thromboembolism prevention quality standard. NICE quality standard 3. 2010. Available online at . Accessed 12 jan 2015.
    1. Niggebrugge AH, Trimbos JB, Hermans J, Steup WH, Van De Velde CJ. Influence of abdominal-wound closure technique on complications after surgery: a randomised study. Lancet. 1999;353(9164):1563–7. doi: 10.1016/S0140-6736(98)10181-2.
    1. Pöpping DM, Elia N, Marret E, Remy C, Tramèr MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143(10):990–9. doi: 10.1001/archsurg.143.10.990.
    1. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, et al. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227) Ann Surg. 2009;249(6):913–20. doi: 10.1097/SLA.0b013e3181a77c92.
    1. Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk reducing interventions, and preventive strategies. Crit Care Med. 2011;39:2163–72. doi: 10.1097/CCM.0b013e31821f0522.
    1. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005;293(5):589–95. doi: 10.1001/jama.293.5.589.
    1. The PROVE Network Investigators High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014;384(9942):495–503. doi: 10.1016/S0140-6736(14)60416-5.
    1. Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006;243(4):547–52. doi: 10.1097/01.sla.0000207097.38963.3b.
    1. Treschan TA, Kaisers W, Schaefer MS, Bastin B, Schmalz U, Wania V, et al. Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function. Br J Anaesth. 2012;109(2):263–71. doi: 10.1093/bja/aes140.
    1. Vohra RS, Spreadborough P, Johnstone M, Marriott P, Bhangu A, Alderson D, et al. West Midlands Research Collaborative. Protocol for a multicentre, prospective, population-based cohort study of variation in practice of cholecystectomy and surgical outcomes (The CholeS study) BMJ Open. 2015;5:1. doi: 10.1136/bmjopen-2014-006399.
    1. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8. doi: 10.1136/.
    1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139–44. doi: 10.1016/S0140-6736(08)60878-8.

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