A Prospective Study of Postoperative Pulmonary Complications Following Upper Abdominal Surgeries

Abstract

Aim: The aim of the study is to follow prospectively a group of patients undergoing elective upper abdominal surgeries and to observe those developing pulmonary complications post-operatively along with factors associated with an increased risk of developing post-operative pulmonary complications using a standard preoperative and postoperative evaluation.Method:Total of 110 patients admitted with upper abdominal pathologies undergoing elective upper abdominal surgeries in the department of General Surgery,during the period of October 2016 to October 2018 were observed for any pulmonary complications. Results:Study had 51 females and 59 males.38 patients developed PPC,19 were males and 19 females. The age distribution of these patients are 14 out of 38 patients(14%) were in the age group of 21-40 years, 16 out of 38 patients(16%) were in the age group of 41-60 years, 8 out of 38 patients(8%) were in the age group of more than 60 years. Out of 38 patients who developed PPC 15(60.5%) were smokers and 23(39.5%) were non-smokers. 21(55.3%) were underweight,14(36.8%) were normal weight,2 (5.3%) were overweight and 1 (2.6%) was class II obesity. 25(65.8%) had normal preoperative PFT, 6(15.8%) patients had mild obstructive disease,4(10.5%) had moderate obstructive disease and 3(7.9%) had restrictive disease. Among 38 patients with PPC 7(18.4%) had gastric surgeries,4(10.5%) had liver surgeries,9(23.7%) underwent surgeries on gall bladder and CBD, 17(44.7%) had pancreatic surgeries,1(2.6%) had surgery on spleen.Among 38 patients who developed PPC all of them had cough with sputum and raised WBC count,32 had fever,37 had abnormal breath sounds,2 had decreased oxygen haemoglobin saturation less than 90%,13(34.2%) patients had unilateral pleural effusion,10(26.3%) had bilateral pleural effusion,3(7.9%) had unilateral consolidation and 12(31.6%) had normal chest x-ray and 11(10%) had positive sputum culture.Conclusion:Patients undergoing upper abdominal surgeries are at a higher risk of developing Postoperative pulmonary complications.Age and Sex are not the significant risk factors for developing PPC.There is a significant correlation between the altered pre-operative pulmonary functions diagnosed by pulmonary function tests and developing PPC.BMI is not a significant risk factor to determine occurrence of PPC.Smoking may not be a significant risk factor to develop PPC.There is a significant relation between the type of upper abdominal surgery and the occurrence of PPC.Cough with sputum ,Fever and Abnormal breath sounds are the most common signs and symptoms seen in patients developing PPC.Pleural effusion is the most common radiological evidence of pulmonary pathology seen in patients with PPC.All patients with postoperative positive sputum culture developed PPC.

Incidence and Associated Factors of Postoperative Pulmonary Complications after Abdominal Surgery in the Public Hospital, Addis Ababa, Ethiopia

“… Postoperative pulmonary complications: the occurrence of 2 or more of the signs and symptoms for at least 2 consecutive days, occurring within 7 days of surgery [ 12 , 16 – 19 ] Abnormal breath sounds: rhonchi/rales/decreased breath sounds BAL/sputum culture-positive infective cause confirmed Cough with sputum+ fever ( T > 38) Physicians/nurses' judgment of the respiratory cause Respiratory rate >25/min Saturation <90% room air, <94% with 100% oxygen for >2 hours X-ray: consolidation/infiltrates/effusion new findings Abdominal surgery: broadly covers surgical procedures that involve opening the abdomen Postanesthesia care unit: A place where the patient is admitted after surgery and anesthesia to be given by professionals Mobilization is defined as the ability to walk >10 m from the bed [ 20 ] …”

“…Postoperative pulmonary complications: the occurrence of 2 or more of the signs and symptoms for at least 2 consecutive days, occurring within 7 days of surgery [ 12 , 16 – 19 ] Abnormal breath sounds: rhonchi/rales/decreased breath sounds BAL/sputum culture-positive infective cause confirmed Cough with sputum+ fever ( T > 38) Physicians/nurses' judgment of the respiratory cause Respiratory rate >25/min Saturation <90% room air, <94% with 100% oxygen for >2 hours X-ray: consolidation/infiltrates/effusion new findings …”