Saravanan, M (2009) Post Operative Pulmonary complications in patients undergoing Thoracic and Abdominal Surgeries and the role of spirometry and other parameters in predicting post operative pulmonary complications: A Follow up study. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Pulmonary complications are important causes of postoperative morbidity and mortality. Post operative pulmonary complications such as pneumonia, atelectasis, bronchitis, pleural effusion, aspiration and bronchospasm account for increased morbidity, mortality and length of hospital stay for a patient after surgery. In studies conducted over the past 60 yr, reported incidence of postoperative pulmonary complications (POPC) has varied between 5-70%, the highest rates were for upper abdominal and thoracic procedures. The need for a screen test preoperatively to identify the patients at risk has been emphasized for the past several years. In the 1960s several studies concluded that spirometric tests were more sensitive than medical history and physical examination for detecting lung diseases; patients with abnormal preoperative spirometry had a higher risk for postoperative pulmonary complications ; and patients with abnormal spirometry benefit from preoperative respiratory therapy. However, studies have reported that spirometric tests used alone have little clinical usefulness for detecting and preventing postoperative pulmonary complications. This study aimed to determine the incidence of postoperative pulmonary complications after thoracic and upper abdominal surgery and the value of preoperative spirometry and other parameters to predict postoperative pulmonary complications. AIM OF THE STUDY : To evaluate the post operative pulmonary complication (POPC) in patients undergoing thoracic and upper abdomen surgery and to evaluate the role of spirometry and other parameters in predicting post operative pulmonary complication. DESIGN OF THE STUDY : Prospective study. This study was examined and approved by the ethical committee of the institution. MATERIALS AND METHODS : The study was conducted in Cardiothoracic Department and Surgical Gastroenterology, Department of Madras Medical College, Government General Hospital, Chennai. The study started from January 2008 to August 2008. The study population was selected from cardiothoracic and surgical gastroenterology department of GGH. INCLUSION CRITERIA : 1. Elective thoracic surgical patient who performed spirometry in cardiothoracic department. 2. Elective upper abdominal surgical patient who performed spirometry in surgical gastroenterology department. EXCLUSION CRITERIA : 1. Patients who cannot perform spirometry. 2. Patients not willing to enroll themselves in this study. Totally hundred and two patients were selected from CTS (58 patients) and SGE (44 patients) department who were posted for elective surgery. Patient were assessed a day before surgery and monitored for seven days after surgery. Preoperativly all patients were assessed by 1. Body mass index, 2. Smoking history, 3. Co morbid illness, 4. ASA (American society of anesthesiologists) grading, 5. Signs and symptoms of respiratory system, 6. X-Ray chest, 7. Pulmonary function test by Spirometry. RESULTS : Data of 102 patients planned for thoracic and upper abdominal surgery (40 female and 62 male) were analyzed. Patients’ characteristics are shown in Table1. 73 (71.5%) patients had abnormal preoperative spirometry, 24 patients had obstructive, and 49 had restrictive. Actual and percent of predicted values of preoperative spirometric tests of patients. CONCLUSION : The purpose of this study is to indentify the incidence and predisposing factors of post operative pulmonary complication (POPC) in government general hospital, Chennai. Previous studies have shown POPC varied between 5-70%, the highest rates were for upper abdominal and thoracic procedures. Despite many advances in medical and surgical practice, the incidence of POPC has not changed appreciably over the past 35 yr. In our study POPC in thoracic surgery, lung resection and abdominal surgery is 27.5%, 35%, 31.5% respectively. The overall POPC is 29%. POPC increased with 1. age >50 (35.3%) than age <50 (26.4%), 2. BMI >25 (34.6%) than BMI <25 (27.6%), 3. ASA >2 (33.3%) than ASA <2 (21.2%), 4. Smoking history, 5. Diabetes mellitus, 6. FEV 1/FVC <80, 7. FEV 1 <1.25 (40%) than FEV 1 >1.25 (27.6%) and 8. Abnormal spirometry (83.3%) than normal spirometry (16.2%). We conclude that Multiple factors, which include age >50, BMI>25, higher ASA grade, smoking, diabetes mellitus and abnormal findings in preoperative spirometry, are responsible for the genesis of POPC. Hence when spirometry used along with other parameters such as age, BMI, ASA, smoking history and comorbid conditions such as diabetes mellitus improves the prediction of POPC after thoracic and upper abdominal surgery.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Post Operative Pulmonary complications ; patients undergoing Thoracic and Abdominal Surgeries ; spirometry ; parameters ; predicting post operative pulmonary complications ; Follow up study. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Feb 2018 16:44 |
| Last Modified: | 28 Feb 2018 16:44 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5908 |
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