Risk Factors of Postoperative Pulmonary Complications After Vascular Surgery

Vodinh, J.; Bonnet, Francis; Touboul, Chantal; Lefloch, J. P.; Becquemin, J. P.; Harf, Alain

doi:10.1097/00132586-199004000-00026

Cited by 11 publications

(11 citation statements)

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“…In patients who do not have sickle cell anemia, the frequency of pulmonary complications range from 1% to 70% [32][33][34][35][36][37][38][39]. Most of these events were minor and thought to be attributable to atelectasis, which was excluded from this analysis.…”

Section: Discussionmentioning

confidence: 99%

The perioperative complication rate of orthopedic surgery in sickle cell disease: Report of the national sickle cell surgery study group

Vichinsky¹,

Neumayr²,

Haberkern

et al. 1999

Am. J. Hematol.

148

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Orthopedic disease affects the majority of sickle cell anemia patients of which aseptic necrosis of the hip is the most common, occurring in up to 50% of patients. We conducted a multicentered study to determine the perioperative complications among sickle cell patients assigned to different transfusion regimens prior to orthopedic procedures: 118 patients underwent 138 surgeries. The overall serious complication rate was 67%. The most common of these were excessive intraoperative blood loss, defined as in excess of 10% of blood volume. The next most common complication was sickle cell-related events (acute chest syndrome or vaso-occlusive crisis), which occurred in 17% of cases. While preoperative transfusion group assignment did not predict overall complication rates, higher risk procedures were associated with significantly higher rates of overall complications. Transfusion complications were experienced by 12% of the patients. Two patients died following surgery. Both deaths were associated with an acute pulmonary event. The 52 patients undergoing hip replacements experienced the highest rate of complications with excessive intraoperative blood loss occurring in the majority of patients. Sickle cell-related events occurred in 19% of patients, and surgical complications occurred after 15% of hip replacements and included postoperative hemorrhage, dislocated prosthesis, wound abscess, and rupture of the femoral prosthesis. There were twenty-two hip coring procedures. Acute chest syndrome occurred in 14% of the patients. Overall, decompression coring was a safer, shorter operation. A randomized prospective trial to determine the perioperative and long-term efficacy of core decompression for avascular necrosis of the hip in sickle cell disease is needed. In conclusion, this study demonstrates a high rate of perioperative complications despite compliance with sickle cell perioperative care guidelines. Pulmonary complications and transfusion reactions were common. This study supports the results previously published by the National Preoperative Transfusion in Sickle Cell Disease Group. These results stated that a conservative preoperative transfusion regimen to bring hemoglobin concentration to between 9 and 11 g/dl was as effective as an aggressive transfusion regimen in which the hemoglobin S level was lowered to 30%.

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Section: Discussionmentioning

confidence: 99%

The perioperative complication rate of orthopedic surgery in sickle cell disease: Report of the national sickle cell surgery study group

Vichinsky¹,

Neumayr²,

Haberkern

et al. 1999

Am. J. Hematol.

148

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“…[21][22][23] The 'two-hit model' suggests that ARDS and MOF may be precipitated by a secondary insult and that certain surgical procedures can act as important inflammatory insults. 24,25 The potential systemic effects of the reaming process have led to fierce controversy, 26,27 but the basic science of this phenomenon has not been adequately characterised. The reaming procedure has been shown to cause an increase in intramedullary pressure, embolisation of bonemarrow contents into the lung and release of inflammatory mediators.…”

Section: Discussionmentioning

confidence: 99%

Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures

Giannoudis

Smith

Bellamy

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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It has been suggested that reamed intramedullary nailing of the femur should be avoided in some patients with multiple injuries. We have studied prospectively the effect of femoral reaming on the inflammatory process as implicated in the pathogenesis of acute respiratory distress syndrome (ARDS) and multiple-organ failure (MOF). We studied changes in the levels of serum interleukin-6 (IL-6) (proinflammatory cytokine), neutrophil CD11b (C3) receptor expression (activated neutrophil adhesion molecule), serum soluble intracellular adhesion molecule (s-ICAM-1), serum soluble E-selectin (the soluble products of endothelial adhesion molecules) and plasma elastase (neutrophil protease) in a series of patients with femoral fractures treated by nailing. We have also compared reamed nailing with unreamed nailing.We found that the levels of serum IL-6 and elastase rose significantly during the nailing procedure indicating a measurable 'second hit'. There was no clear response in leukocyte activation and no difference in the release of endothelial adhesion molecule markers. There was no significant difference between groups treated by reamed and unreamed nailing. Although clinically unremarkable, the one patient who died from ARDS was shown to be hyperstimulated after injury and again after nailing, suggesting the importance of an excessive inflammatory reaction in the pathogenesis of these serious problems.Our findings have shown that there is a second hit associated with femoral nailing and suggest that the degree of the inflammatory reaction may be important in the pathogenesis of ARDS and MOF.

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“…79,80,89 The risk of postoperative complications also depends on the type of surgery. The rate of complication is higher in patients undergoing abdominal surgery [90][91][92] and is also increased with aortic aneurysm repair, [93][94][95][96] vascular, 74,78,79,93 thoracic, 83,90,93,96 and neck surgery. 83,96,97 Gupta et al have shown an increased risk of postoperative complications (39% vs 18%), higher rate of transfer to ICU (24% vs 9%), and increased length of hospital stay in patients with obstructive sleep apnea compared with control subjects matched for age, sex, and body mass index (BMI).…”

Section: Evidence On Sleep Apnea As a Risk Factor For Perioperative Cmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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Risk Factors of Postoperative Pulmonary Complications After Vascular Surgery

Cited by 11 publications

References 0 publications

The perioperative complication rate of orthopedic surgery in sickle cell disease: Report of the national sickle cell surgery study group

The perioperative complication rate of orthopedic surgery in sickle cell disease: Report of the national sickle cell surgery study group

Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

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