Postoperative pulmonary complications after thoracic and abdominal surgery
According to this study postoperative pulmonary complications (PPC) are well-known after major thoracic and abdominal surgery and are associated with increased mortality, morbidity and prolonged hospital stay. There is no consensus in the literature regarding risk factors for PPC.
To optimize care and prevent PPC, we aimed at identifying the most important preoperative risk factors.
The Delphi method was used as a consensus-seeking approach. A total of 22 health professionals with clinical experience within the field of thoracic or abdominal surgery were invited to participate in the panel. Risk factors identified in the literature were commented on and rated by the panel in a three-round Delphi-process.
The Delphi panel reached consensus on 20 preoperative risk factors for PPC for patients undergoing elective thoracic or abdominal surgery. The risk factors were divided into two categories: related to type of surgery or to the patients' preoperative status. Furthermore, they were categorized as high, moderate or low risk factors. This list of risk factors is considered a qualified starting point for development of a risk assessment tool.
A systematic pre-operative identification of patients at high risk of PPC could be useful to facilitate an early preventive preoperative and postoperative intervention and to allocate proper resources to high risk patients.
Incidence of postoperative pulmonary complications (PPC) in patients undergoing thoracic and abdominal surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. Complications may be related to anesthesia, mechanical ventilation, tissue damage, immobilization and pain. These conditions cause decreased lung volumes and limited airway clearance, which can lead to PPC such as atelectasis, pneumonia and hypoxemia. Health professionals involved in the management of patient undergoing surgery needs to be aware that postoperative pulmonary complications are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care.
A novel approach for identification of preoperative risk factors for postoperative pulmonary complications after thoracic and abdominal surgery has been presented in this paper. The main contribution is in terms of the systematic preoperative identification of patients at high risk of PPC, which could be useful to facilitate an early preventive preoperative and postoperative intervention and to allocate proper resources to high risk patients. The list of risk factors is not yet operational for systematic risk assessment in clinical practice but is considered a starting point for further development of a manageable assessment tool.
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