Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis.
BACKGROUND
Postoperative pulmonary complications (PPCs) after major abdominal surgery are common and associated with significant morbidity and high cost of care. The objective of this study was to identify the risk factors for PPCs after major abdominal surgery.


METHODS
The American College of Surgeons' National Surgical Quality Improvement Program database from 2005-2012 was queried for patients who underwent major abdominal surgery (esophagectomy, gastrectomy, pacnreatectomy, enterectomy, hepatectomy, colectomy, and proctectomy). Predictors of PPCs were identified using multivariate logistic regression.


RESULTS
Of 165,196 patients who underwent major abdominal surgery 9595 (5.8%) suffered PPCs (pneumonia 3.2%, prolonged ventilator support ≥48 h 3.0%, and unplanned intubation 2.8%). On multivariate analysis, significant predictors of overall and individual PPCs include esophagectomy, advanced American Society of Anesthesiology Classification System, dependent functional status, prolonged operative time, age ≥80 y, severe chronic obstructive pulmonary disease, preoperative shock, ascites, and smoking. Obesity was not a risk factor. Female gender was overall protective for PPCs.


CONCLUSIONS
PPCs after abdominal procedures are associated with a number of clinical variables. Esophageal operations and American Society of Anesthesiology Classification System were the strongest predictors. These results provide a framework for identifying patients at risk for developing pulmonary complications after major abdominal surgery.
Department of Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York. Electronic address: chyang@chpnet.org.
Chun Kevin
CK
Yang
Department of Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York.
Annabelle
A
Teng
Department of Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York.
David Y
DY
Lee
Department of Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York.
Keith
K
Rose
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
ACS-NSQIP; Complications; Intubation; Pneumonia; Postoperative; Ventilation