Pulmonary complications after nonthoracic surgery are more frequent than cardiac complications
Mar 1, 2005 - 5:33:38 PM

Of the approximately 45 million North Americans who will undergo nonthoracic surgery during the next year, over 1 million will experience a postoperative pulmonary complication, an event which could have enormous implications for both the patient and health care system. Canadian investigators checked 1,055 consecutive patients attending a presurgical admission clinic at a university hospital to uncover risk factors for pulmonary complications after elective nonthoracic surgery.

According to the authors, pulmonary complications after nonthoracic surgery are more frequent than cardiac complications and are associated with a greater increase in hospital length of stay. Of the 1,055 patients in the study, 28 (2.7 percent) suffered a postoperative pulmonary complication within 7 days after surgery.

Thirteen patients developed respiratory failure requiring ventilatory support, 9 contracted pneumonia, 5 had collapse of lung tissue (atelectasis) requiring bronchoscopic intervention, and 1 suffered a collection of air or gas in the pleural cavity causing the lung to collapse. One patient who had pneumonia subsequently died. The length of stays for patients with postsurgical pulmonary complications were almost 28 days, as contrasted with 4.5 days for patients who had no postsurgical complications.

The four factors associated with an increased risk for pulmonary complications following nonthoracic surgery were: age over 65; a positive cough test (meaning the patient continued to cough after taking a deep breath and providing a voluntary cough); placement of a nasogastric tube at the time of the operation; and long-duration anesthesia (2.5 hours or longer). The researchers called for steps to minimize perioperative intubation unless it is judged very necessary on clinical grounds.

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