Perioperative Outcome And Risk Factors For Patients With Sever Respiratory Dysfunction

Purpose:In order to screening the risk factors which were related to the outcome of the patients with severe respiratory dysfunction who sustained elective upper abdominal and non-cardiac thoracic surgery, We analyzed the relationship between preoperative, intraoperative, postoperative factors and the outcome of these patients.Material and Methods:We reviewed the patients with severe respiratory dysfunction that received upper abdominal and non-cardiac thoracic surgery in Zhongshang hospital from sep. 1 2006 to aug.31 2009. The possible risk factors and outcome of these patients including the occurrence of adverse events peri-operatively, ICU time and post-operative hospitalization was reviewed. All these data was analyzed via monofactor and multifactor regress in order to screening the significant risk factors and build the risk model.Outcome:Perioperative adverse events occurred in 21 patients (21/55,38.18%) and 1 patient died. Postoperative pulmonary complications (PPCs,18/21) and cardiovascular complications(7/21) including sever arrhythmia and heart failure were most common. Monofactor analysis indicated severe mixed ventilation dysfunction(P=0.024), double lumen endotracheal tube intubation (P=0.018), high concentration oxygen inhalation during operation(P=0.038) and FEV1≤0.8L preoperatively (P=0.043) were the risk factors that would increase the incidence rate of perioperative adverse events. Logistic regress indicated that double lumen endotracheal tube intubation (OR=7.08), severe mixed ventilation dysfunction (OR=5.69) and resection or reconstruction of organs (OR=0.20) were the risk factors. Multiple liner regress indicated age (Coef.=0.154976),preoperative PaO2<60mmHg (Coef.=11.71539), preoperative glucocorticosteroid application≥3 days (Coef.=3.121874), upper abdominal surgery (Coef.=-23.53693) and operation related complication (Coef.= 36.47372) were the significant related factors to ICU time; BMI (Coef.= 2.091116), dibetes (Coef.=-9.192909), preoperative serum albumin level (Coef.=-.4028801), preoperative MVV% level(Coef.=-87.31409), simple general anesthesia (Coef.=-6.217967) surgery time (Coef.=0.060829), upper abdominal surgery (Coef.=-15.20421) and surgery related complications (Coef.= 41.37919) were related factors to postoperative hospitalization.Conclusions:There is a high incidence rate of adverse events in patients with severe respiratory dysfunction who sustain elective upper abdominal and non-cardiac thoracic surgery. The main adverse events are postoperative pulmonary complications (PPCs) and cardiovascular complications including severe arrhythmia and heart failure. Mixed ventilation dysfunction, double-lumen endotracheal intubation, high oxygen inhalation, preoperative FEV1≤0.8L are the risk factors that could increase the incidence rate of perioperative adverse events. Increasing of Age, preoperative PaO2<60mmHg, surgery related complication will prolong the ICU time. Increasing of BMI, operation time, the decreasing of preoperative albumin level and MVV% will prolong the postoperative hospitalization.