The reasons of pulmonary complications post liver surgery in Karadeniz Technical University Faculty of Medicine General Surgery Clinic and effectiveness of pulmonary care

Aim: The most common cause of morbidity and mortality after liver surgery is postoperative pulmonary complications (PPC). In the current study, we aimed to investigate the causes of PPCs after hepatectomy and liver transplantation. Additionally, we evaluated the efficacy of postoperative pulmonary care after liver surgery.Materials and methods: Between January 2007 and March 2012, 85 patients (81 patients underwent hepatectomy and 4 patients underwent liver transplantation) were included in the study. Patients with ASA score greater than 2 were evaluated by Department of Pulmonary Diseases. Pulmonary care was started a day after extubation. In cases with PPC, postoperative care was performed with the collaboration of Departments of Pulmonary Diseases and Surgery. Demographic data, laboratory data, preoperative risk factors and operative variables, postoperative complications, mortality, postoperative course and postoperative hospital staying time were recorded.Results: There were 44 men (51.7% ) and 41 women (48.3% ) with a mean age 54 ± 13 years; 14% (n = 12) of patients were older than 70 years, and 19% (n = 16) were classified as ASA 3 or 4. Indications for resection were malignant disease in 59.2% patients (n = 48) and benign disease in 40.8% (n =33). The mortality rate was 7.4% (n = 6) after hepatectomy. The causes of death were pulmonary embolism (n=4) and pneumonia (n = 2). The morbidity rate was 19.7% (n = 16) after hepatectomy. The causes of morbidity were PPC in 10 patients (12% ), SSIs in 4 patients, biliary leak in 4 patients and postoperative liver failure in 1 patient, respectively. Patients who developed PPCs had a statistically significant increase in the length of hospital stay (15.5 ± 11.9 days versus 7.8 ± 4.8 days; P = 0.037). Patients who developed PPC were more frequent admissions to the intensive care unit (ICU) (36.8% versus 1.4% ; P < 0.0001). Sixteen of 19 PPCs were observed in patients with ASA score ?2. The multivariate analysis identified single independent risk factor for PPCs: prolonged operative time.Conclusions: For the prevention from PPCs, identification of risk factors associated with PPCs and the development of effective preventive strategies are crucial. Postoperative pulmonary care should be given to all patients after liver surgery. With our policy, the PPC incidence could be reduced in an acceptable rate.