Postoperative respiratory morbidity: identification and risk factors

Area of Science:

• General Surgery
• Respiratory Medicine
• Clinical Risk Assessment

Background:

• Postoperative respiratory morbidity (PORM) is a significant complication following general surgery.
• Identifying reliable risk factors is crucial for patient management and outcome prediction.

Purpose of the Study:

• To prospectively evaluate the contribution of various risk factors to PORM in general surgery patients.
• To assess the independent predictive value of identified risk factors for PORM.

Main Methods:

• Prospective study of 200 consecutive general surgery patients.
• Assessment of PORM using individual clinical features and an aggregate risk score.
• Analysis of recognized risk factors including respiratory disease, smoking, surgical site, and duration.

Main Results:

• Established risk factors like previous respiratory disease, smoking, and upper abdominal surgery were associated with PORM.
• A naso-gastric tube (NGT) for 24 hours postoperatively was the most significant factor associated with PORM, independently predicting risk.
• Previous respiratory disease was best identified by productive cough, reduced FEV1, and purulent sputum; thereafter, smoking and chronic cough history did not add further predictive value.

Conclusions:

• A naso-gastric tube (NGT) is a key independent predictor of postoperative respiratory morbidity in general surgery.
• While traditional risk factors are relevant, NGT presence offers superior risk identification compared to upper abdominal surgery.
• Specific indicators of previous respiratory disease are more critical than smoking history for predicting PORM.