Abdominal Surgery: Comprehensive Assessment Predicts Postoperative Pulmonary Complications

Postoperative pulmonary complications (PPCs) after major abdominal surgery are common, with risk increasing with patient age. Major abdominal surgeries alter and disrupt diaphragmatic dysfunction, which has been proven causative of PPCs.

Researchers from Mount Sinai St. Luke’s Hospital and Mount Sinai Roosevelt Hospital, New York, concerned about PPCs’ high morbidity and cost, recently used the American College of Surgeons’ National Surgical Quality Improvement Program database to identify the risk factors for PPCs after major abdominal surgery. Patients who develop PPCs remain in the hospital an average of 11 days longer than others and incur $31,000 in excess costs.

These researchers identified 165,196 surgical patients who underwent non-emergent esophagectomy, gastrectomy, pacnreatectomy, enterectomy, hepatectomy, colectomy, and proctectomy—the abdominal surgeries considered major and most likely to be associated with PPCs—between 2005 and 2012.

Overall, approximately 6% of patient experienced PPCs. PPCs could be divided into pneumonia (3.2%), prolonged ventilator support within 48 hours (3%), and unplanned intubation (2.8%).

Likelihood of developing PPCs was elevated by a factor of 5 in patients with esophagectomy, probably due to proximity to the diaphragm. Factor that doubled risk included American Society of Anesthesiology Classification System rating, dependent functional status, and prolonged operative time. These risk factors aren’t modifiable; the best surgeons can do is acknowledge them and monitor postoperatively.

Advanced age (older than 80 years), severe chronic obstructive pulmonary disease, preoperative shock, ascites, and smoking also doubled risk of PPCs.

Obese patients had risk similar to non-obese patients and female sex was overall protective for PPCs.

Identifying patients at risk for developing pulmonary complications after major abdominal surgery can help monitor for adverse outcomes and catch them early when possible. This study appears in the Journal of Surgical Research.