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Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study. 2023
Federico Piccioni, and
Lorenzo Spagnesi, and
Paolo Pelosi, and
Elena Bignami, and
Marcello Guarnieri, and
Luca Fumagalli, and
Enrico Polati, and
Vittorio Schweiger, and
Daniela Comi, and
Rocco D'Andrea, and
Pierangelo DI Marco, and
Savino Spadaro, and
Serena Antonelli, and
Liliana Sollazzi, and
Lucia Mirabella, and
Marina Schiavoni, and
Cristiana Laici, and
Jlenia A Marelli, and
Fabio Fabiani, and
Lorenzo Ball, and
Agostino Roasio, and
Giuseppe Servillo, and
Matteo Franchi, and
Patrizia Murino, and
Marco Irone, and
Vieri Parrini, and
Germano DE Cosmo, and
Giuseppe Cornara, and
Franco Ruberto, and
Gilda Pasta, and
Lorenzo Ferrari, and
Massimiliano Greco, and
Maurizio Cecconi, and
Giorgio Della Rocca, and
Anesthesia Unit1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy - dr.federico.piccioni@gmail.com.
Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. We conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality. PPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001). The incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery.
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