Post-Operative Pulmonary Complication

Original Editor - Ronald Yip

Top Contributors - Hing Long Yip and Kim Jackson  

Introduction

Postoperative pulmonary complication is an umbrella term of adverse changes to the respiratory system occurring immediately after surgery.[1] The most common presentations include altered function of respiratory muscles, reduced lung volume, respiratory failure and atelectasis.[1]

Incidence and Impact

Up to 23% of patient underwent major surgery would suffer from PPCs.[1] In fact, the incidence of PPCs is more common than cardiac complication.[2] With people who sustain PPCs, 14% to 30% die within 30 days after a major surgery compared to only 0.2% to 3% of patient who does not have PPCs. [3][4] In terms of morbidity, PPCs, increases length of hospital stay by 13 - 17 days.[1]

List of PPCs

Risk Factors

There are a range of factors to predict the development of PPCs, which are divided into modifiable and non-modifiable.[1]

Non-Modifiable

  • Age - > 60 or 65 years is found to have increased risk.[5]
  • Surgery type - Abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, neurosurgery and major vascular surgery are found to have higher risk than other types of surgery.[6][7]

Modifiable

  • Co-morbidity - Patient with the following conditions has higher risk in development of PPCs: Chronic obstructive pulmonary disease, congestive heart failure, chronic liver disease.[8]
  • Smoking
  • Preoperative anaemia
  • General anaesthesia - the use of GA disturbs many aspects of respiratory function, hence increases risk of patient developing PPCs.[1]
  • Low tidal volume - People who have lower tidal volume spontaneously are categorised as a higher risk.[1]
  • Neuromuscular blocking drugs
  • Nasogastric tube

PPC and Physiotherapy

Physiotherapy services are considered preventative measures in different stages of recovery.[1]

Preoperative

Preoperative aerobic exercise and inspiratory muscle training are recommended to reduce PPCs and LOS in cardiac and abdominal surgery patients.[9] It is found that preoperative IMT reduces postoperative atelectasis and pneumonia.[10]

Postoperative

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Miskovic A, Lumb AB. Postoperative pulmonary complications. BJA: British Journal of Anaesthesia. 2017 Mar 1;118(3):317-34.
  2. Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. Journal of general internal medicine. 1995 Dec 1;10(12):671-8.
  3. Herbstreit F, Peters J, Eikermann M. Impaired Upper Airway Integrity by Residual Meeting AbstractsIncreased Airway Collapsibility and Blunted Genioglossus Muscle Activity in Response to Negative Pharyngeal Pressure. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2009 Jun 1;110(6):1253-60.
  4. Kor DJ, Warner DO, Alsara A, Fernández-Pérez ER, Malinchoc M, Kashyap R, Li G, Gajic O. Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology. 2011 Jul;115(1):117.
  5. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar 1;111(3):564-71.
  6. Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, Eikermann M. Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2013 Jun 1;118(6):1276-85.
  7. Arozullah AM, Khuri SF, Henderson WG, Daley J. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Annals of internal medicine. 2001 Nov 20;135(10):847-57.
  8. Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, Eikermann M. Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2013 Jun 1;118(6):1276-85.
  9. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical rehabilitation. 2011 Feb;25(2):99-111.
  10. Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clinical rehabilitation. 2015 May;29(5):426-38.