There are over a million postoperative pulmonary complications (PPCs) each
year in the United States resulting in 46,200 deaths and 4.8 million
hospitalizations days, suggest current estimates. Most of these PPCs are considered mild (i.e.
needing prolonged supplemental oxygen), difficult to measure and often
ignored in clinical studies.
postoperative pulmonary complications are significantly
associated with increased death within the first week after surgery, revealed researchers at the University of Colorado Anschutz Medical Campus,
along with seven other major institutions.The study, which appeared online in the journal JAMA Surgery
examined 1,202 patients who underwent abdominal, orthopedic,
neurological and other procedures under general anesthesia for at least
‘Even mild postoperative pulmonary complications are significantly associated with increased death within the first week after surgery.’
"We found that patients with one or more PPCs, even mild, had
significantly increased intensive care unit admission, ICU/hospital
length of stay and early postoperative mortality," said Ana
Fernandez-Bustamante, associate professor of anesthesiology at
the University of Colorado School of Medicine. She and Marcos Francisco
Vidal Melo, associate professor at the Massachusetts General
Hospital, Harvard University, are the lead authors of the article.
Fernandez-Bustamante and her colleagues, including Karsten Bartels, assistant professor of anesthesiology at CU Anschutz, set out to
understand these PPCs better and how to address them.
They studied patients classified as "physical status 3" by the
American Society of Anesthesiologists, meaning they suffered severe
systemic disease. The patients underwent prolonged, non-cardiac or
thoracic surgery with general anesthesia and mechanical ventilation.
A third of them developed one or more PPCs after surgery. These
patients were often older with hypertension, cancer or chronic
obstructive pulmonary disease.
Severe complications were rare. The most common complication was
simply requiring oxygen for longer than 24 hours after the operation.
That was followed by atelectasis (or portions of the lungs being
But even these relatively mild complications were associated with
significantly increased hospital stay, admission to the ICU or mortality
within the first week after surgery.
And this was observed at seven large American academic hospitals.
"This tells us that care could be improved," Fernandez-Bustamante
said. "If we could understand better and prevent mild PPCs we could
improve the recovery of thousands of patients."
Doctors know that giving patients too many fluids or too big breaths during anesthesia can cause pulmonary problems afterwards.
Fernandez-Bustamante said that paying more attention to preventing
atelectasis, for example, before, during and after surgery, could reduce
some of them, improve oxygenation and prevent the need of oxygen
therapy and hospital stay.
She noted that physicians must also optimize fluids and pain
control, and minimize blood loss during operations to prevent PPCs.
Doing all of this, she said, could improve patient outcomes and result
in shorter hospital stays.
"Surgeons, anesthesiologists, nurses, respiratory therapists, and
others, must collaborate better to make this successful. And of course
patients need to know they play a critical role in their own recovery.
We must work with them closely before, during and after surgery,"
Fernandez-Bustamante said. "If we want patients to have less pulmonary
complications, we need a truly comprehensive approach to this problem."