Exploring National Surgical Quality Improvement Program respiratory comorbidities: developing a predictive understanding of postoperative respiratory occurrences, Clavien 4 complications, and death

Published:February 14, 2013DOI:



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ferguson M.K.
        Preoperative assessment of pulmonary risk.
        Chest. 1999; 115: 585
        • Bartlett R.
        • Brennan M.L.
        • Gazzaniga A.B.
        • et al.
        Studies on the pathogenesis and prevention of postoperative pulmonary complications.
        Surg Gynecol Obstet. 1973; 137: 925
        • Garibaldi R.A.
        • Britt M.R.
        • Coleman M.L.
        • et al.
        Risk factors for postoperative pneumonia.
        Am J Med. 1981; 70: 677
        • Qaseem A.
        • Snow V.
        • Fitterman N.
        • et al.
        Risk assessment for and strategies to reduce peri-operative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians.
        Ann Intern Med. 2005; 144: 575
        • Khuri S.F.
        The NSQIP: a new frontier in surgery.
        Surgery. 2005; 138: 837
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187
        • Clavien P.A.
        • Sanabria J.R.
        • Strasberg S.M.
        Proposed classification of complication of surgery with examples of utility in cholecystectomy.
        Surgery. 1992; 111: 518
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205
        • Canet J.
        • Mazo V.
        Postoperative pulmonary complications.
        Minerva Anestesiol. 2010; 76: 138
        • Warner M.A.
        • Divertie M.B.
        • Tinker J.H.
        Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients.
        Anesthesiology. 1984; 60: 380
        • Dyle R.
        Assessing and modifying the risk of postoperative pulmonary complications.
        Chest. 1999; 115: 77S
        • Silva D.R.
        • Gazzana M.B.
        • Knorst M.M.
        Merit of preoperative clinical findings and functional pulmonary evaluations as predictors of postoperative pulmonary complications.
        Rev Assoc Med Bras. 2010; 56: 551
        • Gracey D.R.
        • Divertie M.B.
        • Didier E.P.
        Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease.
        Chest. 1979; 76: 123
        • Kroenke K.
        • Lawrence V.A.
        • Theroux J.F.
        • et al.
        Operative risk on patients with severe obstructive pulmonary disease.
        Arch Intern Med. 1992; 152: 967
        • Stein M.
        • Cassara E.L.
        Preoperative pulmonary evaluation and therapy for surgery patients.
        JAMA. 1970; 211: 787
        • Wightman J.A.
        A prospective survey of the incidence of postoperative pulmonary complications.
        Br J Surg. 1968; 55: 85
        • Pedersen T.
        • Viby-Morgensen J.
        • Ringsted C.
        Anesthetic practice and postoperative pulmonary complications.
        Acta Anaestesiol Scand. 1992; 36: 812
        • Arozullah A.M.
        • Khuri S.F.
        • Henderson W.G.
        • et al.
        Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery.
        Ann Intern Med. 2001; 135: 847