Risk scoring to predict postoperative pulmonary complications of patients who were consulted to Hacettepe University chest diseases department for preoperative evaluation

It has been a significant issue to carry out preoperative assessment for surgical patients. It is necessary to make a decision by foreseeing potential risks according to the type of the surgery and the features of the patient. One of the most frequent circumstances that result in mortality and morbidity in the postoperative period is pulmonary complications. Various national and international researches have been conducted to predict postoperative pulmonary complications and Canet score has been validated. However, the validation of Canet risk scoring was not performed in Turkey. Moreover, the system of Canet scoring was implemented only for general patient population, but there is not a scoring system to predict the postoperative risks for each patient who is consulted to the chest diseases clinics. The aim of the research is to develop a scoring system to predict the postoperative pulmonary complications for the patients who were consulted to the chest diseases clinic with the purpose of preoperative assessment. The research was carried out as prospective and single center. Patients who were consulted by surgical branches in Hacettepe University for preoperative assessment were included in the research. Preoperative demographic data of the patients and their pulmonary assessment results were recorded and patients were followed up in the postoperative period till they were discharged from the hospital. Besides, patients' pulmonary symptoms were checked via telephone calls in the end of the first month. The primary endpoint was the determination of the development of respiratory complications such as respiratory failure, coughing, sputum, fever, bronchospasm, respiratory tract infection, atelectasis, pleural effusion in the portoperative period. A total of 203 patients were included in the research. Of the patients 55.7 % (n=113) were female and 44.3 % (n=90) were male. The mean age of the patients was 60.59 ± 14.93 (18-91). In the first month of postoperative period, it was shown that at least one pulmonary complication occurred in 36.4 % of the patients (n=74), but in the end of the first month, the rate of the patients whose symptoms continued or new complications occurred was 22.7% (n=46). In the first month of postoperative period, 23.2 % of the patients (n=47) had bronchospasm, 17.2 % of the patients (n=35) had atelectasis, 12.8 % of the patients had a fever, 12.3 % of them (n=25) had sputum, 12.5 % of them (n=25) needed supplemental oxygen, 7.9 % of them (n=16) had pneumonia and 7.4 % of them (n=15) had pleural effusion. Being over the age of 60 (p=0.022) years, having preoperative cough (p=0.031), sputum (p=0.054) and dyspnea (p=0.017), presence of rhonchus (p=0.001) in physical examination, BMI≤24.9 kg/m2 (p=0.010), having the findings of air trapping in the chest X-ray (p=0.004), being an ex-smoker (p=0.005), having primary malignancy other than lung cancer (together with lung metastasis or not) (p=0.022), upper abdominal or thoracic surgery (p=0.001), duration of surgery for more than 3 hours (p=0.011), having an operation in autumn (p=0.001) and preoperative lower Hb level (p=0.044) were the factor associated with postoperative pulmonary complications. Significant risk factors in the regression model were upper abdominal or thoracic surgery, cough, dyspnoea and season of the surgery (p<0.05). In conclusion, a model in order to predict the postoperative pulmonary complications for the patients who were consulted to the clinic of chest diseases with the purpose of preoperative pulmonary assessment was developed. Type of the surgery, having preoperative cough, dyspnea and the season in which the surgery was performed were the variables in the modelling. Keywords: Preoperative pulmonary evaluation, postoperative pulmonary complication