Postoperative Pulmonary Complications After Laparoscopic Surgery: Risk Factors and Predictive Scores

Background: Laparoscopic surgery is associated with postoperative pulmonary complications (PPCs) that may lead to increased morbidity and prolonged hospital stay. This study aimed to identify risk factors for PPCs within the first 7 days following laparoscopic surgery. Methods: We conducted a prospective observational study including patients scheduled for laparoscopic surgery between June 2021 and June 2024. The primary endpoint was the incidence of PPCs, defined according to the Joint Task Force of the European Society of Anaesthesiology and the European Society of Intensive Care Medicine (ESA and ESICM). Secondary endpoints included other postoperative complications as well as hospital and post-anesthesia care unit (PACU) length of stay. Demographic data, intraoperative variables, Air Test, incidence of PPCs, and hospital length of stay were collected. Logistic regression analysis was performed to identify factors associated with the development of PPCs. Results: A total of 250 patients were included in the study. PPCs occurred in 34 patients (14.4%). Laparoscopic upper abdominal surgeries (p = 0.086) and longer surgical duration (p = 0.025) were associated with a higher incidence of PPCs. Independent risk factors identified for PPCs were age over 60 years (OR: 2.29; 95% CI 1.03-5.08; p = 0.041) and a positive Air Test result (OR: 6.22; 95% CI 2.11-18.22; p = 0.001). Patients in the PPC group had significantly higher rates of postoperative infectious complications, as well as longer stays in both the post-anesthesia care unit (PACU) and the hospital. The Air Test demonstrated acceptable discriminative performance, with an area under the ROC curve (AUC) of 0.66 (95% CI: 0.58-0.74; p = 0.002). Conclusions: The incidence of PPCs in patients undergoing laparoscopic surgery was 14.4%. Factors independently associated with PPCs included advanced age and a positive postoperative Air Test. However, the Air Test demonstrated modest accuracy in predicting PPCs.