The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

Abstract

BackgroundThe burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors.MethodsA retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present.ResultsOut of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%.ConclusionPPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

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

“…Surgical duration longer than 3 hours would be 11 times more likely to have postoperative pulmonary complications ( p ≤ 0.001, AOR: 11.7, 95% CI: 3.62–38.03). This finding is in line with different pieces of the literature studied by different researchers abroad [ 3 , 12 , 15 ]. The possible explanation may be the long duration of surgery was associated with an altered physiological response of metabolic activities [ 13 , 25 ].…”

“…Several works of the literature showed a wide variation in the occurrence of postoperative pulmonary complications ranging from 5 to 60% [ 1 , 3 – 23 ]. Variation of definitions, preoperative tests to identify the associated risk, criteria used to diagnose, and diverse populations in different countries were the major contributory factors for developing postoperative pulmonary complications in a wide range [ 1 ].…”

“…Many studies abroad have identified risk factors for postoperative pulmonary complications. e most identified risks are ASA > III, age ≥ 65 years, history of upper respiratory tract infection, use of general anesthesia, the presence of comorbidities, smoking, alcoholism, low socioeconomic status, desaturation less than 94%, serum albumin less than 3.5 gm/dl, intraoperative bleeding, hemoglobin less than 10 g/dl, intraoperative blood transfusion, prolonged surgery, postoperative mechanical ventilation, long hospital stay, cardiac surgery, history of previous respiratory diseases, poor postoperative pain control, use of neuromuscular blocking drugs, and early ambulation (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

The predictive role of computed tomography on respiratory complications following coronary artery bypass surgery

“…No research has been found in the literature to investigate this relationship. The presence of atelectasis is a pathology that will cause problems in both operative and postoperative procedures for almost any type of surgery performed under general anesthesia.This negative relationship has been addressed in many studies and the importance of correcting this pathology preoperatively with various cautions has been highlighted [10][11][12]. Also parallel to the studies known so far, it has also been demonstrated that even band atelectasis is a risk for postoperative hypoxemia.…”

Ameliyat Sonrası Dönemde Solunum Egzersizi Günlüğü Kullanımının Düzenli Spirometre Kullanımına Etkisi: Randomize Kontrollü Çalışma

“…Özellikle büyük cerrahi girişimlerin (toraks ve batın cerrahisi gibi) sonrasında solunum komplikasyonları %12.5-%54.5 arasında değişen oranlarda görülmekte olup, cerrahi insizyonun diyafragmaya yakın olması durumunda bu oranların arttığı bildirilmektedir [6][7][8][9] . Literatürde torasik ve abdominal cerrahide %42.4 10 , torasik cerrahide %6.2 11 , üst abdominal cerrahide %20 12 oranında solunum komplikasyonlarının görüldüğü bildirilmektedir. Ameliyat sonrası dönemde görülen solunum komplikasyonları arasında sıklıkla atelektazi ve enfeksiyonlar (akut bronşit, pnömoni gibi) yer almaktadır [13][14][15] .…”