Researchers find that even mild pulmonary complications after surgery can pose major risks

November 9, 2016

Researchers at the University of Colorado Anschutz Medical Campus, along with seven other major institutions, have found that even mild postoperative pulmonary complications (PPCs) are significantly associated with increased death within the first week after surgery.

The study, which appeared online today in the journal JAMA Surgery, examined 1,202 patients who underwent abdominal, orthopedic, neurological and other procedures under for at least two hours.

"We found that patients with one or more PPCs, even mild, had significantly increased intensive care unit admission, ICU/hospital length of stay and early postoperative mortality," said Ana Fernandez-Bustamante, MD, PhD, associate professor of anesthesiology at the University of Colorado School of Medicine. She and Marcos Francisco Vidal Melo, MD, PhD, associate professor at the Massachusetts General Hospital, Harvard University, are the lead authors of the article.

Current estimates suggest that there are over a million PPCs each year in the U.S. resulting in 46,200 deaths and 4.8 million hospitalizations days. Most of these PPCs are considered mild (i.e. needing prolonged supplemental oxygen), difficult to measure and often ignored in clinical studies.

Fernandez-Bustamante and her colleagues, including Karsten Bartels, MD, assistant professor of anesthesiology at CU Anschutz, set out to understand these PPCs better and how to address them.

They studied patients classified as "physical status 3" by the American Society of Anesthesiologists, meaning they suffered severe systemic disease. The patients underwent prolonged, non-cardiac or thoracic with general anesthesia and mechanical ventilation.

A third of them developed one or more PPCs after surgery. These patients were often older with hypertension, cancer or chronic .

Severe complications were rare. The most common complication was simply requiring oxygen for longer than 24 hours after the operation. That was followed by atelectasis (or portions of the lungs being partially collapsed).

But even these relatively mild complications were associated with significantly increased hospital stay, admission to the ICU or mortality within the first week after surgery.

And this was observed at seven large American academic hospitals.

"This tells us that care could be improved," Fernandez-Bustamante said. "If we could understand better and prevent mild PPCs we could improve the recovery of thousands of patients."

Doctors know that giving patients too many fluids or too big breaths during anesthesia can cause pulmonary problems afterwards.

Fernandez-Bustamante said that paying more attention to preventing atelectasis, for example, before, during and after surgery, could reduce some of them, improve oxygenation and prevent the need of oxygen therapy and hospital stay.

She noted that physicians must also optimize fluids and pain control, and minimize blood loss during operations to prevent PPCs. Doing all of this, she said, could improve patient outcomes and result in shorter hospital stays.

"Surgeons, anesthesiologists, nurses, respiratory therapists, and others, must collaborate better to make this successful. And of course patients need to know they play a critical role in their own recovery. We must work with them closely before, during and after surgery," Fernandez-Bustamante said. "If we want to have less pulmonary complications, we need a truly comprehensive approach to this problem."

Explore further: Ultraviolet air sterilizer reduces sepsis and mortality in cardiac surgery patients

Related Stories

Ultraviolet air sterilizer reduces sepsis and mortality in cardiac surgery patients

October 17, 2016
An ultraviolet air steriliser reduces sepsis and mortality in cardiac surgery patients, according to research presented today at Acute Cardiovascular Care 2016.

How is health-related quality of life for kids with postconcussion symptoms?

October 24, 2016
Children with persistent postconcussion symptoms reported lower overall, physical, emotional, social and school quality of life for at least 12 weeks after concussion than children whose concussion symptoms resolved more ...

Patients benefit from tranexamic acid in surgery, withholding blood pressure meds before

October 27, 2016
Four innovative studies exploring ways to reduce complications related to heart surgery or minimize patient mortality due to risks associated with low blood pressure and surgery were highlighted during the Anesthesiology ...

Factors for higher risk of death following hip fracture surgery than hip replacement

September 15, 2015
Patients undergoing surgery for a hip fracture were older and had more medical conditions than patients who underwent an elective total hip replacement, factors that may contribute to the higher risk of in-hospital death ...

Loss of independence after surgery for older patients associated with increased risk of hospital readmission

July 13, 2016
In a study published online by JAMA Surgery, Julia R. Berian, M.D., of the American College of Surgeons, Chicago, and colleagues examined loss of independence (LOI; defined as a decline in function or mobility, increased ...

Poorer outcomes after non-cardiac surgery in DM

September 11, 2013
(HealthDay)—For patients undergoing non-cardiac surgery, diabetes is associated with adverse perioperative complications and mortality, according to a study published online Aug. 29 in Diabetes Care.

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.