Skip to main content

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.

Publication ,  Journal Article
Fernandez-Bustamante, A; Frendl, G; Sprung, J; Kor, DJ; Subramaniam, B; Martinez Ruiz, R; Lee, J-W; Henderson, WG; Moss, A; Mehdiratta, N ...
Published in: JAMA Surg
February 1, 2017

IMPORTANCE: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. OBJECTIVE: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. DESIGN, SETTING, AND PARTICIPANTS: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. EXPOSURE: Noncardiothoracic surgery. MAIN OUTCOMES AND MEASURES: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. RESULTS: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67-3.89; and age [in years]: OR, 1.03, 95% CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01-1.24) factors. CONCLUSIONS AND RELEVANCE: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

February 1, 2017

Volume

152

Issue

2

Start / End Page

157 / 166

Location

United States

Related Subject Headings

  • Time Factors
  • Tidal Volume
  • Risk Factors
  • Respiratory Insufficiency
  • Respiration, Artificial
  • Prospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Pelvis
  • Oxygen Inhalation Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fernandez-Bustamante, A., Frendl, G., Sprung, J., Kor, D. J., Subramaniam, B., Martinez Ruiz, R., … Vidal Melo, M. F. (2017). Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg, 152(2), 157–166. https://doi.org/10.1001/jamasurg.2016.4065
Fernandez-Bustamante, Ana, Gyorgy Frendl, Juraj Sprung, Daryl J. Kor, Bala Subramaniam, Ricardo Martinez Ruiz, Jae-Woo Lee, et al. “Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.JAMA Surg 152, no. 2 (February 1, 2017): 157–66. https://doi.org/10.1001/jamasurg.2016.4065.
Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017 Feb 1;152(2):157–66.
Fernandez-Bustamante, Ana, et al. “Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.JAMA Surg, vol. 152, no. 2, Feb. 2017, pp. 157–66. Pubmed, doi:10.1001/jamasurg.2016.4065.
Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, Lee J-W, Henderson WG, Moss A, Mehdiratta N, Colwell MM, Bartels K, Kolodzie K, Giquel J, Vidal Melo MF. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017 Feb 1;152(2):157–166.

Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

February 1, 2017

Volume

152

Issue

2

Start / End Page

157 / 166

Location

United States

Related Subject Headings

  • Time Factors
  • Tidal Volume
  • Risk Factors
  • Respiratory Insufficiency
  • Respiration, Artificial
  • Prospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Pelvis
  • Oxygen Inhalation Therapy