Document Detail

Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?
MedLine Citation:
PMID:  20805178     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Postoperative pulmonary complications (PPC) are the most frequently observed complications following lung resection, of which pneumonia and atelectasis are the most common. PPCs have a significant clinical and economic impact associated with increased observed number of deaths, morbidity, length of stay and associated cost. The aim of this study was to assess the incidence and impact of PPCs and to identify potentially modifiable independent risk factors. METHODS: A prospective observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 13 months. PPC was assessed using a scoring system based on chest x-ray, raised white cell count, fever, microbiology, purulent sputum and oxygen saturations. RESULTS: Thirty-four of 234 subjects (14.5%) had clinical evidence of PPC. The PPC patient group had a significantly longer length of stay (LOS) in hospital, high dependency unit (HDU) LOS, higher frequency of intensive care unit (ITU) admission and a higher number of hospital deaths. Older patients, body mass index (BMI) > or =30 kg/m(2), preoperative activity <400 m, American Society of Anesthesiologists (ASA) score > or =3, smoking history, chronic obstructive pulmonary disease (COPD), lower preoperative forced expiratory volume in 1 s (FEV(1)) and predicted postoperative (PPO) FEV(1) were all significantly (p<0.05) associated with PPC on univariate analysis. Multivariate analysis confirmed that age >75 years, BMI > or =30 kg/m(2), ASA > or =3, smoking history and COPD were significant independent risk factors in the development of PPC (p<0.05). CONCLUSION: The clinical impact of PPCs is marked. Significant independent preoperative risk factors have been identified in current clinical practice. Potentially modifiable risk factors include BMI, smoking status and COPD. The impact of targeted therapy requires further evaluation.
P Agostini; H Cieslik; S Rathinam; E Bishay; M S Kalkat; P B Rajesh; R S Steyn; S Singh; B Naidu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Thorax     Volume:  65     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2010-10-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  815-8     Citation Subset:  IM    
Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
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MeSH Terms
Body Mass Index
Forced Expiratory Volume
Intensive Care Units / statistics & numerical data
Length of Stay / statistics & numerical data
Middle Aged
Pneumonia / etiology
Postoperative Complications
Prospective Studies
Pulmonary Atelectasis / etiology
Pulmonary Disease, Chronic Obstructive / complications
Risk Factors
Smoking / adverse effects
Thoracic Surgical Procedures / adverse effects*

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