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Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by
Jacqueline C Stocking1, Christiana Drake2, J Matthew Aldrich3
1Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Davis, 4150 V Street, Suite 3400, Sacramento, CA, 95817, USA. jcstocking@ucdavis.edu.
Insights
Late postoperative respiratory failure (L-PRF) in adults is linked to worse outcomes. Pre-existing neurologic disease, longer anesthesia, and high peak inspiratory pressures are key risk factors for L-PRF.
Area of Science:
- Medical research
- Surgical outcomes
- Respiratory medicine
Background:
- Postoperative respiratory failure (PRF) following elective surgery is a significant concern.
- Early PRF (E-PRF) and late PRF (L-PRF) may have distinct causes and consequences.
- Understanding L-PRF is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the risk factors and outcomes associated with late PRF (L-PRF).
- To compare L-PRF with early PRF (E-PRF) and patients without PRF (No-PRF).
Main Methods:
- Retrospective matched case-control study of 59,073 adult patients undergoing elective surgery.
- Patients with L-PRF were matched 1:1 with No-PRF controls.
- Risk factors and outcomes were analyzed comparing L-PRF, E-PRF, and No-PRF groups.
Main Results:
- L-PRF was associated with higher morbidity, mortality, longer hospital/ICU stays, and increased costs compared to No-PRF.
- Risk factors for L-PRF included pre-existing neurologic disease (OR 4.36), anesthesia duration per hour (OR 1.22), and peak inspiratory pressure (OR 1.14).
- These factors were identified compared to No-PRF patients.
Conclusions:
- Pre-existing neurologic disease, prolonged anesthesia, and high intraoperative peak inspiratory pressures are associated with L-PRF.
- Interventions targeting these identified risk factors warrant further investigation.
- L-PRF represents a distinct clinical entity with significant adverse outcomes.
Background:
Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF.
Methods:
This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF.
Results:
Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81-10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04-1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06-1.22).
Conclusions:
We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.
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