Abstract
Background
For preoperative risk stratification, little is known about the implications of respiratory
comorbidities in relation to postoperative complications in the diverse population
of surgical patients. We hypothesized that patients with preoperative respiratory
comorbidities would be at increased risk of postoperative respiratory occurrences
and death.
Methods
Under the data use agreement and with the approval of the Henry Ford Health System
Institutional Review Board (IRB #6830), we reviewed 5 y (2005–2009) of National Surgical
Quality Improvement Program participant use files. Respiratory comorbidities were
defined as current smoker, chronic obstructive pulmonary disease, dyspnea, and current
pneumonia. Respiratory outcomes tracked in the National Surgical Quality Improvement
Program included reintubation, postoperative pneumonia, and prolonged ventilation.
We defined Clavien 4 and 5 outcomes to include postoperative septic shock, postoperative
dialysis, pulmonary embolism, myocardial infarction, cardiac arrest, prolonged ventilatory
requirements, need for reintubation, and death.
Results
Of 971,455 patients identified, 361,412 had respiratory comorbidities. As the number
of respiratory comorbidities increased, we found a statistically significant increase
in the occurrence of postoperative respiratory adverse events, including Clavien 4
and 5 complications. Multivariate regression analysis showed that respiratory comorbidities
and age were independent predictors of mortality. All data reported here were significant
at P < 0.001.
Conclusions
This study showed a significant association between respiratory comorbidities and
postoperative adverse events, including Clavien 4 complications and death. Further
prospective studies are required to explore this association.
Keywords
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Article info
Publication history
Published online: February 14, 2013
Accepted:
January 17,
2013
Received in revised form:
December 22,
2012
Received:
August 1,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
