Prospective Evaluation Of Risk Factors For Postoperative Pulmonary Complications

Background: Accompained by acceleration of the process of China’saging population and constantly improve the level of medical technology, thetypes of acceptable surgical treatment of diseases and the scope and number ofpatients with the growing, and thus the incidence of postoperative complica-tions is also increasing, including postoperative respiratory complications(PPCs). PPCs have a higher prevalence, a heavy burden to the community andthe patients’ families, so it should be attracted enough attention. Currentknowledge of the risk for postoperative pulmonary complications rests onstudies that narrowly selected patients and procedures, and the definition ofPPCs in the different studies is different, thus affecting the representativenessof the study results and analysis. Therefore, an extensive, large sample, theprospective survey of PPCs-related risk factors, we aimed to develop apredictive risk index for a broad surgical population, preoperative riskassessment system is very necessary.Purpose: We aimed to study the incidence of patients with postoperativerespiratory complications in our hospital. The application of statistical methodsvalidation risk factors associated with PPCs, and according to that an objective,easy accessed risk factors, we establish a preoperative scoring system to assessPPCs occurrence of the degree of risk, at the same time, evaluate high-riskpatient population. It can be a guidance of a variety of clinical settings.Methods: This study was a prospective, randomized, multi-factor clinicaltrials, patients with a follow-up of seven days in a row, by containing a varietyof risk factors, structured questionnaire, the preoperative, intraoperative, andpostoperative status were observed and recorded. This study included2050 medical records of hospitalized patients in the hospital undergoing surgery inJune2011to March2012,according to exclusion criteria and data integrity ofthe experiment, the final number of samples included in this study2037. Thisstudy will PPCs defined to include respiratory failure (mild respiratory failure/severe respiratory failure), acute lung injury (ALI)/acute respiratory distresssyndrome (ARDS), suspicious lung infection, pulmonary infiltrates, effusionsof the pleura, atelectasis, pneumothorax, bronchospasm, aspirationpneumonitis, cardiopulmonary edema. The risk factors associated with PPCswere analysised by statistical methods. A PPC predictive index wasconstructed.Results:(1)Of2037patients studied,493patients with postoperativepulmonary complications were observed (24.2%).(2)Logistic regressionmodeling identified six independent risk factors: low preoperative arterialoxygen saturation, acute respiratory infection during the previous month, age,preoperative anemia, location of surgery, surgical duration.(3)The area underthe receiver operating characteristic curve was90%for the developmentsubsample and87%for the validation subsample.Conclusion: The risk scoring system based on six objective, easilyassessed factors has excellent discriminative ability and convenient. The riskscoring system can be used to assess individual risk of PPC and focus furtherresearch on preoperative status adjustment and PPCs prevention and treatmenthas important clinical significance.