Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.003
Brazilian Journal of Anesthesiology
Clinical Research

Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study

Fatores de Risco para Complicações Pulmonares Pós-Operatórias e Hospitalização Prolongada em Pacientes Submetidos a Ressecção Pulmonar: Estudo Retrospectivo

Clovis T. Bevilacqua Filho, André P. Schmidt, Elaine A. Felix, Fabiana Bianchi, Fernanda M. Guerra, Cristiano F. Andrade

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Abstract

Background
Postoperative pulmonary complications are the main cause of morbidity and mortality after pulmonary resection. This study was undertaken to determine the risk factors associated with postoperative pulmonary complications (PPCs) and length of hospital stay (LOS) in pulmonary resection patients in a tertiary teaching hospital in Brazil.

Methods
A retrospective data gathering from 196 patients who underwent pulmonary resection between 2012 and 2016 was conducted. Demographic and hospital admission data were collected from patients with complete medical records. Univariate analysis was performed, followed by Poisson’s regression for predicting the prevalence of postoperative pulmonary complications and length of hospital stay.

Results
Thirty-nine patients (20%) displayed pulmonary complications in the postoperative period. The risk factors associated with an increased prevalence of postoperative pulmonary complications in a multivariate analysis were: American Society of Anesthesiologists Physical Score ≥ 3 (PR 4.77, p = 0.03, 95% CI: 1.17 to 19.46), predicted diffusion capacity of the lungs for carbon monoxide – corrected single breath (PR 0.98, p < 0.001, 95% CI: 0.96 to 0.99) and age of the patient (PR 1.04; p = 0.01; 95% CI: 1.01 to 1.06). Those associated with an increased prevalence of prolonged hospital stay were: duration of surgical procedure longer than five hours (PR 6.94, p = 0.01, 95% CI 1.66 to 12.23), male sex (PR 5.72, p < 0.001, 95% CI 1.87 to 9.58), and presence of postoperative pulmonary complications (PR 11.92, p < 0.001, 95% CI 7.42 to 16.42).

Conclusions
The rate of postoperative pulmonary complications in the study population is in line with the world average. Recognizing risk factors for the development of PPCs may help optimize allocation resources and preventive efforts.

Keywords

Pleural effusion Pneumonia;  Pneumothorax;  Acute respiratory distress syndrome;  Pulmonary atelectasis;  Thoracotomy;  Ventilator-induced lung injury

Resumo

Introdução: A complicação pulmonar pós-operatória é a principal causa de morbidade e mortalidade após ressecção pulmonar. Realizamos este estudo para determinar os fatores de risco associados às complicações pulmonares pós-operatórias (CPP) e ao tempo de permanência hospitalar (TPH) de pacientes submetidos a ressecção pulmonar em hospital universitário terciário no Brasil. Métodos: Foram obtidos retrospectivamente dados de 196 pacientes submetidos a ressecção pulmonar entre 2012 e 2016. Dados demográficos e da internação hospitalar foram coletados dos pacientes com prontuário completo. Análise univariada seguida de regressão de Poisson foram realizadas para prever a prevalência de complicações pulmonares pós-operatórias e o tempo de permanência hospitalar. Resultados: Observamos complicações pulmonares no pós-operatório em 39 pacientes (20%). Os fatores de risco associados a maior prevalência de complicações pulmonares pós-operatórias revelados pela análise multivariada foram: o escore da classificação do estado físico ASA≥ 3 (RP 4,77, p = 0,03, IC 95%: 1,17 a 19,46), o valor previsto pós-operatório da capacidade de difusão pulmonar ao CO pelo método da respiração única (RP 0,98, p <0,001, IC95%: 0,96 a 0,99) e a idade do paciente (RP 1,04; p = 0,01; IC 95%: 1,01 a 1,06). Os fatores associados a maior prevalência de hospitalização prolongada foram: duração da cirurgia superior a cinco horas (RP 6,94, p = 0,01, IC95%: 1,66 a 12,23), sexo masculino (RP 5,72, p <0,001, IC95%: 1,87 a 9,58) e a ocorrência de complicações pulmonares pós-operatórias (RP 11,92, p <0,001, IC95%: 7,42 a 16,42). Conclusões: A taxa de complicações pulmonares pós-operatórias observada na população estudada é análoga à média mundial. A determinação dos fatores de risco para o desenvolvimento de CPP pode auxiliar na otimização das medidas preventivas e da distribuição dos recursos.

Palavras-chave

Derrame pleural, pneumonia, pneumotórax, síndrome do desconforto respiratório agudo, atelectasia pulmonar, toracotomia, lesão pulmonar induzida por ventilador.

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