title: Preoperative pulmonary evaluation (PPE) as a prognostic factor in patients undergoing upper abdominal surgery.
abstract: OBJECTIVE
  Upper abdominal operations are relatively high risk for postoperative pulmonary complications. The influences of general anesthesia and an operative procedure are well known to negatively impact pulmonary gas exchange. For this reason, the preoperative pulmonary evaluation (PPE) should emphasize risk factors for pulmonary complications. The prediction of these complications is still an under-investigated field. The aim of this study is to identify risk indicators for pulmonary complications after elective upper abdominal operations.
  
  
  METHODS
  A standardized PPE was performed on 28 patients (mean age 53 years) who were admitted to the Intensive Care Unit (ICU) of the Hospital of Athens after scheduled extensive upper abdominal surgery. The PPE included physical examination, medical history, smoking history and general laboratory tests including chest X-ray, and arterial blood gases and spirometry. The type of surgical operation and duration of anesthesia were also evaluated. Postoperatively, data was collected on the occurrence of a symptomatic and clinically significant pulmonary complication.
  
  
  RESULTS
  All 28 patients (57.2% female, 42.8% male) needed mechanical ventilator (MV) support after surgery because of respiratory failure and the mean time of MV was 4 +/- 2 days. During this period, 6 (21.4%) patients developed nosocomial pneumonia, 3 (10.7%) developed acute respiratory distress syndrome (ARDS), 2 (6.1%) had a small atelectasis and 4 (14.2%) developed bleeding disorders. Eventually, 2 (7.1%) of the patients with ARDS developed sepsis and died during hospitalization in ICU. All patients who developed complications had a medical history of mild COPD, chronic obstructive pulmonary disease (COPD), a smoking history, were operated on for underlying malignancies and also had abnormal preoperative laboratory results.
  
  
  CONCLUSIONS
  Pulmonary complications have enormous implications for the patient and the health care system. The first step in reducing postoperative complications is to identify which patients are at increased risk. PPE is the better way to select clinical and laboratory factors that allow risk stratification for postoperative pulmonary complications after upper abdominal surgery.
authors.affiliation: Athens University School of Nursing, Intensive Care at Trauma, Hospital of Athens KAT, Kifisia, Athens, Greece. grigorakos@parliament.gr
authors.forename: Leonidas
authors.initials: L
authors.lastname: Grigorakos
authors.forename: Evangelia
authors.initials: E
authors.lastname: Sotiriou
authors.forename: Despina
authors.initials: D
authors.lastname: Koulendi
authors.forename: Anastasia
authors.initials: A
authors.lastname: Michail
authors.forename: Stauroula
authors.initials: S
authors.lastname: Alevizou
authors.forename: Penelopi
authors.initials: P
authors.lastname: Evagelopoulou
authors.forename: Stelios
authors.initials: S
authors.lastname: Karatzas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ligidakis
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors