Journal of Korean Academy of Fundamentals of Nursing (기본간호학회지)

Korean Academy of Fundamentals of Nursing (기본간호학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Intensive Care Unit Patients' Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

외과중환자실에 입실한 복부수술 환자의 수술 후 폐합병증 발생 위험요인에 대한 연구

  • Joo, Soon Yeo (Surgical Intensive Care Unit, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hee-Seung (Department of Nursing, College of Nursing, The Catholic University of Korea)
  • 주순여 (가톨릭대학교 서울성모병원 외과중환자실) ;
  • 김희승 (가톨릭대학교 간호대학)
  • Received : 2018.10.05
  • Accepted : 2019.02.08
  • Published : 2019.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to identify the risk factors for postoperative pulmonary complications (PPCs) after upper or lower abdominal digestive tract surgery. Methods: Participants in this retrospective observational study had undergone upper or lower digestive tract surgery and entered the surgical intensive care unit between March 1, 2016 and February 28, 2017. Data were collected from the medical records, operative records, results of laboratory test, and the nursing records of the hospitals. Results: Of the patients, 544 patients were enrolled in the study and PPCs -developed in 335 (61.6%) patients. On multivariate logistic regression analysis, significant risk factors of PPCs were identified: BMI (Body Mass Index; $kg/m^2$), preoperative serum BUN (Blood Urea Nitrogen; mg/dL), abdominal open surgery, or blood transfusion during operation. Conclusion: These risk factors could be used to help identify patients at risk for PPCs and then appropriate nursing interventions could be provided for patients at risk of PPCs.

Keywords

References

  1. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bulletin of the World Health Organization. 2016;94(3):201-209f. https://doi.org/10.2471/blt.15.159293
  2. National Health Insurance Service. The Main Surgery Statistical Yearbook for 2015 [Internet]. Gangwon: National Health Insurance Service; 2015 [cited 2018 Oct 1]. Available from: http://www.nhis.or.kr/bbs7/boards/B0079/22272?boardKey=33&sort=sequence&order=desc&rows=10&messageCategoryKey=&pageNumber=1&viewType=generic&targetType=12&targetKey=33&status=&period=&startdt=&enddt=&queryField=&query=
  3. Lawson EH, Hall BL, Louie R, Ettner SL, Zingmond DS, Han L, et al. Association between occurrence of a postoperative complication and readmission: Implications for quality improvement and cost savings. Annals of Surgery. 2013;258(1):10-18. https://doi.org/10.1097/SLA.0b013e31828e3ac3
  4. Thanavaro JL, Foner BJ. Postoperative pulmonary complications. Nursing Critical Care. 2016;11(1):38-47. https://doi.org/10.1097/01.CCN.0000475517.50129.0a
  5. Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350. https://doi.org/10.1097/ALN.0b013e3181fc6e0a
  6. Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. Journal of Surgical Research. 2015;198(2):441-449. https://doi.org/10.1016/j.jss.2015.03.028
  7. Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia. 2017;118(3):317-334. https://doi.org/10.1093/bja/aex002
  8. Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surgery. 2017;152(2):157-166. https://doi.org/10.1001/jamasurg.2016.4065
  9. Jeong BH, Shin B, Eom JS, Yoo H, Song W, Han S, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PloS One. 2014;9(12):e113656. https://doi.org/10.1371/journal.pone.0113656
  10. Beaussier M, Genty T, Lescot T, Aissou M. Influence of pain on postoperative ventilatory disturbances. Management and expected benefits. Annales Francaises d'Anesthcsie et de Reanimation. 2014;33(7-8):484-486. https://doi.org/10.1016/j.annfar.2014.07.005
  11. Canet J, Sabaté S, Mazo V, Gallart L, de Abreu MG, Belda J, et al. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. European Journal of Anaesthesiology. 2015;32(7):458-470. https://doi.org/10.1097/EJA.0000000000000223.
  12. Doh YJ, Hur IK, Lee JY, Park JB, Sung NI, Lee YG, et al. Reappraisal of the predictive factors for postoperative pulmonary complications after general anesthesia. Korean Journal of Medicine. 2007;72(5):501-510.
  13. Hokari S, Ohshima Y, Nakayama H, Suzuki R, Kajiwara T, Koya T, et al. Superiority of respiratory failure risk index in prediction of postoperative pulmonary complications after digestive surgery in Japanese patients. Respiratory Investigation. 2015;53(3):104-110. https://doi.org/https://doi.org/10.1016/j.resinv.2014.12.004
  14. Chon SY, Kyung SY, Kim YJ, An CH, Lee SP, Park JW, et al. A prospective study for risk factors predicting postoperative pulmonary complications. Tuberculosis and Respiratory Diseases. 2007;62(6):516-522. https://doi.org/10.4046/trd.2007.62.6.516
  15. Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Practice & Research: Clinical Anaesthesiology. 2010;24(2):157-169. https://doi.org/10.1016/j.bpa.2009.12.002.
  16. Choi PJ, Jeong SS. Clinical Analysis of Risk Factors in Pulmonary Complications after Curative Resection of Esophageal Cancer. Korean Journal of Bronchoesophagology. 2011;17(2):98-103.
  17. Souza Possa S, Braga Amador C, Meira Costa A, Takahama Sakamoto E, Seiko Kondo C, Maida Vasconcellos AL, et al. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. Revista Portuguesa de Pneumologia. 2014;20(2):69-77. https://doi.org/10.1016/j.rppneu.2013.07.005.
  18. Canet J, Gallart L. Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Current Opinion in Critical Care. 2014;20(1):56-62. https://doi.org/10.1097/MCC.0000000000000045
  19. Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clinic Proceedings. 2013;88(11):1241-1249. https://doi.org/10.1016/j.mayocp.2013.06.027
  20. Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, et al. The epidemiology and risk factors for postoperative pneumonia. Journal of Clinical Medicine Research. 2017;9(6):466-475. https://doi.org/10.14740/jocmr3002w
  21. Inokuchi M, Kojima K, Kato K, Sugita H, Sugihara K. Risk factors for post-operative pulmonary complications after gastrectomy for gastric cancer. Surgical Infections. 2014;15(3):314-321. https://doi.org/10.1089/sur.2013.031
  22. Ohkura Y, Shinohara H, Shindoh J, Haruta S, Ueno M, Sakai Y, et al. A new scoring system using preoperative factors and contour mapping for predicting postoperative complications of laparoscopic gastrectomy. Digestive Surgery. 2016;33(1):74-81. https://doi.org/10.1159/000442028.
  23. Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Annals of Surgery. 2005; 241(2):219-226. https://doi.org/10.1097/01.sla.0000151791.93571.70
  24. Kim YB, Chang CH, Kim SY, Nam YT. Effect of BMI and Patient Positioning on Airway Pressures and Respiratory Compliance during Laparoscopic Surgery. Korean Journal of Anesthesiology. 2006;50(3):302-307. https://doi.org/10.4097/kjae.2006.50.3.302
  25. Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: Results from the patient safety in surgery study. Journal of the American College of Surgeons. 2007;204(6):1188-1198. https://doi.org/10.1016/j.jamcollsurg.2007.02.070.
  26. O'Neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ. 2016;354:i3292. https://doi.org/10.1136/bmj.i3292
  27. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522-538. https://doi.org/10.1097/ALN.0b013e31823c1067
  28. Lee CZ, Kao LT, Lin HC, Wei PL. Comparison of clinical outcome between laparoscopic and open right hemicolectomy: A nationwide study. World Journal of Surgical Oncology. 2015;13:250. https://doi.org/10.1186/s12957-015-0666-7
  29. Blum JM, Stentz MJ, Dechert R, Jewell E, Engoren M, Rosenberg AL, et al. Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology. 2013;118(1):19-29. https://doi.org/10.1097/ALN.0b013e3182794975
  30. Lee WS, Yang YL, Oh EG. Effectiveness of deep breathing exercise for postoperative pulmonary complications prevention: A systematic review. Journal of Korean Academy of Fundamental Nursing. 2014;21(4):423-432. https://doi.org/10.7739/jkafn.2014.21.4.423

Cited by

  1. Factors Influencing Complications after Therapeutic Lung Resection in Lung Cancer Patients vol.27, pp.2, 2019, https://doi.org/10.7739/jkafn.2020.27.2.106