Preoperative evaluation of elective abdominal surgery patients and comparison of postoperative pulmonary complication indexes

Abstract Preoperative Evaluation of Elective Abdominal Surgery Patients and Comparison of Postoperative Pulmonary Complication Indexes GÜLSEN Askin, MD. * Advisor: KILINC Oguz, MD, Assoc. Prof of Chest Disease * Dokuz Eylul University Faculty of Medicine, Chest Disease Department Izmir / Turkey Purpose; The aim of this study is to evaluate the patients who will undergo abdominal surgery preoperatively, calculate the indexes, monitor the postoperative pulmonary complications (PPC) and compare the result with indexes. Materials and Methods; The patients who were hospitalized in the General Surgery Department of our hospital and scheduled for elective abdominal surgery between July 2005 and July 2006 were included in the study. The patients were evaluated during the last week before surgery. Each patient went through symptom query and physical examination. ASA scores were obtained from anesthesia department's records. Ebstein and Shapiro scores, postoperative respiratory failure, pneumonia indexes and Nottingham Health Profile scores were calculated. The treatment of the the patients who were considered to be at risk or those newly diagnosed with COPD was rearranged and their operations were postponed. After the postoperative 48th hour the patients underwent physical examination again and were reevaluated in terms of their symptoms. The patients with pulmonary or non-pulmonary complications were recorded. Statistical Analysis; The acquired data were entered into SPSS statistical software (for Windows 14.0) and statistically analyzed. The rates of postoperative respiratory and non respiratory complication development in abdominal surgery were compared to the parameters pertaining to the patient and operation. The factors affecting PPC was evaluated with the chi-square test ( %2 ), the differences between the grouped data with student-t test, and the parameters which were determined with measurements and which did not meet the parametric conditions were evaluated with Mann Whitney-U test. A confidence interval at the 95% confidence level was determined by using chi-square analysis ( %2 ), Odds Ratio and Miettinen's formula for the indexes determining the postoperative complications. The results were evaluated in the 95% confidence interval and a P value <0.05 was considered significant. xnResults: The results obtained showed that the rate of complications determined were 48.2 %, 37.5 % and 10.7 % in upper abdominal, lower abdominal and laparoscopic surgical operations, respectively. The rates of pleural effusion and pneumonia in patients who underwent liver transplantation were 96% and 20%, respectively. It was determined that the mean age of patients with complications was higher than those without complications. Preoperative pathological physical examination or simple respiratory function test parameters were beneficial in the prediction of the complications. Prolongation of the surgical period and the accommodation in the postoperative intensive care unit caused an increase in the rate of complications. Fewer complications were seen in the laparoscopic surgical operations compared to the other incisions. The average Nottingham Health Profile score among the patients who died or had complications was determined as 150 and above. A six to sevenfold increase in PPC was determined as ASA and pneumonia index scores were above 3 and respiratory failure score was above 4. Upon respiratory failure and pneumonia index scores above 3, a 25.5 fold and 36.4 fold increase in the occurrence of non-respiratory complications were observed, respectively. ASA, Shapiro and Ebstein indexes did not help the prediction of death in our study. Conclusion; The preoperative evaluation of the patients and the prediction of postoperative pulmonary complications are important for reducing mortality and shortening the duration of hospitalization. The results obtained in our study showed that approximately one thirds (1/3) of the patients were still smoking in the preoperative period and it was observed that this behavior increased the complications in the elective operations performed for the diseases with few symptoms. Preoperative physical examination revealed pathological findings, which is, by itself, a predictor of a high incidence of postoperative complications. As to the indexes, it was observed that ASA, Ebstein and Shapiro scoring could not predict mortality sufficiently and the components of Ebstein index alone did not help the prediction of complications, however, the respiratory failure and pneumonia indexes developed in the recent years could provide a better prediction of both respiratory and non-respiratory complications. The postoperative pneumonia index in particular could provide a better prediction of death as well as the complications. It was concluded that preoperative low quality of life caused a significant increase in complications and the incorporation of quality of life scoring into the indexes mentioned above might be beneficial. Key words: Preoperative evaluation, Risk indexes, Elective abdominal surgery, Postoperative pulmonary complications, Notthingham Health Profile Xlll