Ramkumar, P P (2018) To analyze the Preoperative respiratory status and Postoperative respiratory complications of Chronic Obstructive Pulmonary Disease patients undergoing abdominal surgery in a tertiary care hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: COPD is a well known independent risk factor for development of postoperative pulmonary complications after abdominal surgery. Many factors influence the incidence of postoperative pulmonary complications. Postoperative pulmonary complications are one of the most important causes of postoperative morbidity and mortality. AIM AND OBJECTIVES: 1. To analyze the Preoperative respiratory status and Postoperative respiratory complications of Chronic Obstructive Pulmonary Disease patients undergoing abdominal surgery in a tertiary care hospital. 2. To determine the association between potential risk factors and postoperative pulmonary complication among COPD patients undergoing abdominal surgery. 3. To assess the efficacy of ARISCAT risk index in predicting the postoperative pulmonary complications. MATERIALS AND METHOD: A prospective observation study was done in COPD patients who underwent elective abdominal surgery in RGGGH, Chennai over a period of 14 months (April 2016 – June 2017). 249 COPD patients who satisfied the inclusion and exclusion criteria were enrolled in the study. Development of postoperative pulmonary complications were observed and we evaluated the relationship between postoperative pulmonary complications and various preoperative and intraoperative factors to identify the risk factors. RESULTS: 23% had one or more postoperative pulmonary complications. The most common complication was respiratory failure (10.8%) followed by pneumonia and atelectasis (8.8%). Multivariant analysis showed age > 60 years, Grade 3 mMRC, Respiratory infection in the past month preoperative FEV1 ≤ 50%, current smokers, pack years > 40, ASA class ≥ 3, duration of surgery > 3 hours, general anaesthesia, upper abdominal surgical site incision, laparotomy, were the risk factors had significant increase in developing postoperative pulmonary complications. Postoperative pulmonary complications significantly increased the length of hospital and ICU stay. Regarding ARISCAT risk score 72% of patient at high risk and 27% at intermediate risk developed postoperative pulmonary complication. High scorers had 97.5 odds and moderate scorers had 14.06 odds of getting postoperative pulmonary complications respectively. Patient with lower score had significant lower complications. CONCLUSION: Postoperative pulmonary complications have profound effect on outcome. ARISCAT risk index is a potential tool to predict postoperative pulmonary complications. It also has the advantage of being simple to calculate manually. Strategies need to be considered to reduce postoperative pulmonary complications.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Postoperative pulmonary complications ; Risk factor ; Abdominal surgery ; Chronic obstructive pulmonary disease ; Risk score. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Jul 2018 16:42 |
| Last Modified: | 20 Jul 2018 16:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8928 |
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