Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC)

Abstract

Background Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF. Methods This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF. Results Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81–10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04–1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06–1.22). Conclusions We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.

Volume Incentive Spirometry Reduces Pulmonary Complications in Patients After Open Abdominal Surgery: A Randomized Clinical Trial

“…All these factors can impair the function of respiratory muscles, leading to a decrease in functional residual capacity and vital capacity. 29 In this study, the functional capacity of the patients preoperatively was assessed by 6MWT and the results showed that there was no significant difference in all the related indicators including walk distance, Borg-score, MAP, HR, and SpO2 between the two groups. However, SpO2 in the VIS group was significantly higher than that in the control group on the 3rd and 5th postoperative day, indicating that postoperative hypoxemia was reduced by using VIS.…”

Anesthesia and perioperative pain relief in the frail elderly patient

“…[ 25 26 27 28 ] Clinical frailty ≥4, as assessed according to the Clinical Frailty Scale, is considered the threshold representative of frailty, which has a robust impact on the incidence of postoperative severe complications as studied on elderly patients with colorectal surgery. [ 11 15 27 28 29 30 ] Studies using the most commonly applied index in surgical cohorts across multiple surgical specialties, that is, the modified Frailty Index (mFI), showed that frailty is associated with a higher rate of all-cause complications and mortality. [ 16 ] mFI is easy to calculate and uses characteristics extracted from the patient’s history and examination.…”