Predictive Factors Involved in Development of Postoperative Pulmonary Complications

The effectiveness of ARISCAT Risk Index, other scoring systems, and parameters in predicting pulmonary complications after thoracic surgery

The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index, which is frequently used in nonthoracic surgery, may not be sufficient to predict postoperative pulmonary complications (PPCs). We aimed to evaluate the effectiveness of the ARISCAT risk index, ASA, preoperative albumin level, neutrophil/lymphocyte ratio (NLR), and other parameters in predicting PPCs after thoracic surgery. Patients undergoing elective thoracic surgery with 1-lung ventilation (OLV) were prospectively analyzed. Demographic data, ARISCAT score, ASA, Nutritional Risk Score-2002, NLR, white blood cell counts, albumin, hemoglobin levels, intraoperative complications, postoperative average visual analogue scale (VAS) score for pain at the 24th-hour, the length of stay in the postoperative intensive care unit, chest tube removal time, postoperative complications, and discharge time were recorded. Patients were assessed for morbidity and mortality on the 90th-day. 120 patients' data were analyzed. PPCs developed in 26 patients. The development of PPCs was statistically significant in patients with high ARISCAT scores (P = .002), high ARISCAT grades (P = .009), and ASA III (P = .002). The albumin level was statistically significantly lower in patients who had mortality within 3 months (P = .007). When scoring systems and laboratory parameters were evaluated together, patients with high ARISCAT grade, Albumin < 35g/L, and ASA III had significantly higher development of PPCs (P = .004). ARISCAT risk index and ASA were found to be significant in predicting PPCs after thoracic surgery. They were also valuable when evaluated in combination with preoperative albumin levels. Additionally; age, male gender, duration of surgery, and duration of OLV were also found to be associated with PPCs.

Predicting Pulmonary Complications Following Upper and Lower Abdominal Surgery: ASA vs. ARISCAT Risk Index

Objective

Postoperative pulmonary complications (POPC) account for a substantial proportion of risk related to surgery and anaesthesia. The American Society of Anesthesiologists (ASA) classification and the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index correlate well with POPC. Here, we compared their accuracy in predicting pulmonary complications following upper and lower abdominal surgery.

Methods

We retrospectively reviewed the medical records of patients undergoing upper and lower abdominal surgery. We collected patients’ demographic data, comorbidities, preoperative pulmonary risk score, laboratory results, surgical data, respiratory tract infection history within one month before surgery, surgical urgency, ASA scores and pulmonary complications within one month after the surgery.

Results

We evaluated 241 patients [upper abdominal surgery (UAS) n=121; lower abdominal surgery (LAS) n=120; mean age 55.7±3.1 years]. In the UAS, 55.8% of the patients were male. In LAS, all patients were female. In both groups, the most common POPC was pleural effusion with compressive atelectasis (CA). Regarding risk score, in both groups, patients with high-risk developed a higher rate of pulmonary complications [UAS (50%), LAS (40%)]. In patients with low-risk scores, the rate of pulmonary complications was significantly lower than the intermediate and high-risk groups (p<0.001). A positive correlation was observed between preoperative risk score and complications (UAS r=0.34; LAS r=0.35 p<0.05). No association was observed between the ASA scores and POPC (p=0.8).

Conclusion

The ASA classification was found to be a weaker modality than ARİSCAT risk index to predict pulmonary complications after the upper and lower abdominal surgeries.

The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary Complications and Hospital Length of Stay in Postoperative Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients.

DATA SOURCES

PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang databases were searched until July 2018.

STUDY SELECTION

Randomized controlled trials (RCTs) comparing HFNO with conventional oxygen therapy or noninvasive mechanical ventilation in adult postoperative patients were included. The primary outcomes were hospital LOS and PPCs; short-term mortality (defined as intensive care unit, hospital, or 28-day mortality) and intubation rate were the secondary outcomes.

DATA EXTRACTION

Demographic variables, high-flow oxygen therapy application, effects, and side effects were retrieved. Data were analyzed by the methods recommended by the Cochrane Collaboration. The strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation. Random errors were evaluated with trial sequential analysis.

DATA SYNTHESIS

Fourteen studies (2568 patients) met the inclusion criteria and were included. Compared to the control group, the pooled effect showed that HFNO was significantly associated with a shorter hospital stay (mean difference: -0.81; 95% confidence interval [CI]: -1.34 to -0.29, P = .002), but not mortality (risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P = .06) and PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P = .18) with HFNO versus control group was recorded.

CONCLUSIONS

The available RCTs suggest that, among the adult postoperative patients, HFNO therapy compared to the control group significantly reduces hospital LOS.

The Carrico index is the parameter that guides the requirement of oxygen in the postoperative period in patients undergoing head and neck surgery under general anaesthesia: a cross-sectional study

BACKGROUND & AIMS

Altered lung function and consequent decrease in oxygenation has been linked to the duration of anaesthesia. This necessitates oxygen monitoring and supplementation in the perioperative period. But, evidence is lacking regarding the parameter that guides best the oxygen supplementation in the postoperative period and the parameter that correlates best with the duration of anaesthesia.

METHODS

Adult patients scheduled for head & neck surgery under general anaesthesia were recruited. Two radial arterial blood samples one at pre-induction and the other at one hour after extubation were obtained. Primary outcome measures were partial pressure of oxygen (PaO2), saturation (SpO2), arterial oxygen content (CaO2) and Carrico index (PaO2/FiO2) and their relation with duration of anaesthesia.

RESULTS

Data from 112 patients showed a hypoxaemia incidence of 11.6%. We observed a drop in the mean CaO2 and haemoglobin concentration but a rise in the mean PaO2 at recovery. The mean PaO2/FiO2 deteriorated by 225.65 ± 72.46 (95% CI 367.66, 83.64, p = 0.000) at recovery and there was a significant correlation (r = 0.2, p = 0.03) between duration of anaesthesia and decrease in PaO2/FiO2 at recovery with a regression coefficient of 0.27 (95% CI 0.02, 0.50).

CONCLUSIONS

The Carrico index was proven to be the best parameter which needs to be monitored perioperatively to detect the alteration in the gaseous exchange in patients undergoing general anaesthesia for head and neck surgery. There is a positive correlation between the decrease in the Carrico index and the duration of anaesthesia especially when it is prolonged beyond 150 minutes.

American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant

OBJECTIVES

Patients with chronic renal failure are prone to pulmonary complications. Renal transplant recipients should undergo complete preoperative evaluation to determine risk of postoperative pulmonary complications. The American Society of Anesthesiologists classification and the Assess Respiratory Risk in Surgical Patients in Catalonia risk index correlate well with incidence of postoperative pulmonary complications. Here, we compared their accuracy in predicting pulmonary complications following renal transplant.

MATERIALS AND METHODS

We retrospectively reviewed medical records of renal transplant recipients between years 2004 and 2015. We collected patient data on Assess Respiratory Risk in Surgical Patients in Catalonia risk index, including demographics, smoking history, comorbidities, preoperative pulmonary risk score, laboratory results, surgery information, history of lower respiratory tract infection 1 month pretransplant, urgency of surgery, American Society of Anesthesiologists classification, and pulmonary complications within 1 month posttransplant.

RESULTS

Of 172 patients (123 males; mean age 38.82 y), 22 (12.8%) developed pulmonary complication during the first month posttransplant, including effusion (9 patients), pneumonia (10 patients), respiratory inefficiency (2 patients), and pulmonary embolism (1 patient). Atelectasis was observed in 95.4% of patients with complications. A positive correlation was observed between age and development of complications (r = 0.171; P = .025). Regarding risk score, 75% of patients at high risk and 19.5% at intermediate risk developed pulmonary complications. Patients with low-risk scores had significantly lower complications than intermediate- and high-risk groups (P < .001). A positive correlation was observed between preoperative risk score and complications (r = 0.34; P < .001). There was no association between the American Society of Anesthesiologists scores and postoperative complications (P = .7).

CONCLUSIONS

The American Society of Anesthesiologists classification was found to be a weaker modality to predict pulmonary complications after renal transplant; as it relates to the general health status, than the Assess Respiratory Risk in Surgical Patients in Catalonia risk index.