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Incidence of postoperative pulmonary complications _PPC_ following

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Incidence of postoperative pulmonary complications _PPC_ following Powered By Docstoc
					        Risk Factors for Postoperative
     Pulmonary Complications following
               Thoracic Surgery


    Agostini, Paula1; Cieslik, H.1; Rathinam, S.1; Singh, S.2; Rajesh, P.B.1; Steyn, R.S.1;
    Naidu, U.B.V.1


1
 Heart of England NHS Foundation Trust, UK
2 Coventry University, UK
  Background
 Postoperative pulmonary complications (PPC)
    most frequent complication
        Atelectasis/Pneumonia
 Significant clinical and economic impact
 Risk factors for PPC include age/ lung function
 It is of increasing importance to identify current PPC risk
  factors as;
   treating modifiable factors could improve UK resection
    rates
   pre and postoperative management strategies could be
    optimised
Aims
 Assess incidence of PPC following thoracotomy and
 lung resection in current UK practice

 Identify risk factors independently associated with
 PPC
Methods
  Prospective observational study
  Regional Thoracic Centre
  Consecutive thoracotomy/ lung resection
  Oct 2007 to Oct 2008
  PPC score - Daily
 PPC Score
          Melbourne Group Scale (MGS) (Reeve et al, 2008)
                    PPC = 4 or more factors:



 chest x-ray - atelectasis/           purulent sputum
  consolidation                        O2 sats <90% on air
 elevated WCC >11.2                   Physician diagnosis
 Pyrexia >38                          HDU/ITU care for
 Microbiology                           respiratory care
Data collection
      Age
      BMI                        PPC scores
      % FEV1                     LOS
      ppoFEV1                    LOS HDU
      ASA                        ITU admission
      COPD                       Mortality
      Current smoking
      Pre-op activity level
      Post-op mobility
      Analgesia
      Operative procedure
Demographics n=234
  Male                       137    (59%)
  Age (mean ± SD) years      63     (14)
  BMI (mean ± SD)            26.2   (4.6)
  Percent FEV1 (mean ± SD)   81%    (20)


  ASA ≥ 3                    131    (56%)
  COPD                       37     (15.8%)
  Current Smoking            36     (15.4%)
  Lung cancer                206    (88%)
Operative procedures
 Outcomes
   34 (14.5%) patients had PPC

                                PPC Group         Non- PPC Group
                                (n=34)            (n=200)        p value

Mortality                       11.8%    (n=4)    0.5%    (n=1)   p<0.0001


ITU admission                   26.5%    (n=9)    1.5%    (n=3)   P<0.0001

LOS (days) median (95%CI)       14      (5- 42)   5      (2-10)   P<0.0001

HDU LOS (days) median (95%CI)   4       (1-12)    1      (1- 4)   P<0.0001
Univariate analysis of risk
factors
      Significant factors        PPC Group         Non PPC Group
          (p=<0.05)                (n=34)             (n=200)

 Age yrs median(95%CI)      71      (43-83)   65       (31-80)

 BMI ≥ 30                   36.4%   (n=12)    18.2%    (n=34)

 Activity <400 metres       52.9%   (n=18)    26.8%    (n=52)

 ASA ≥ 3                    84.8%   (n=28)    51.5%    (n=102)

 Current smoking            35.2%   (n=12)    11.9%    (n=23)

 COPD                       38.2%   (n=13)    11.9%    (n=23)

 %FEV1 (mean ± SD)          72      ±18       83       ±19
 ppoFEV1 (mean ± SD)        58      ±17       66       ±19
Independent risk factors
- multivariate analysis, stepwise logistic regression

                         Odds Ratio     CI
      Age ≥ 75              3.9       1.5-10.4
      ASA ≥ 3               3.9       1.3-11.5

      Current smoking       7.4       2.6-21.3
      BMI ≥ 30              2.9       1.1-7.7
      COPD                  2.9       1.1-7.6
Conclusion
 The clinical and cost impact of developing a PPC is marked


 5 independent preoperative risk factors have been identified;
 potentially modifiable- COPD/smoking
       pulmonary rehabilitation, including smoking cessation (Bobbio et al
        2008, Sekine et al 2005, Wilson 1997) ? availability

 High risk group identified- optimisation of postoperative
  management
 The impact and timing of targeted therapy on specific groups
  requires further evaluation.
Results
     Brooks-Brunn n=51   Rate of PPC
          MGS n=17
                          Gosselink         6.2%
       Treatment n=16
                          MGS               13.2%

        Gosselink n=8     Brooks-Brunn 39.5%

                          Treatment*        12.4%


                         *antibiotics for pneumonia n=15
                         bronchoscopy for atelectasis n=1
Rate of PPC - comparison
Comparison of first 129 consecutive patients;

•Melbourne Group Scale:          13.2% (n=17)

•pneumonia - antibiotics
 atelectasis - bronchoscopy:     12.4% (n=16)

To establish reliability – 20 patients scored
independently by 2 different assessors

				
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posted:4/23/2011
language:English
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