Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Prospective Study for Risk Factors Predicting Postoperative Pulmonary Complications

수술 후 폐 합병증 발생의 위험 인자에 대한 연구

  • Chon, Su Yeon (Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center) ;
  • Kim, Yu Jin (Department of Internal Medicine, Gachon University and Science, Gil Medical Center) ;
  • Kyung, Sun Young (Department of Internal Medicine, Gachon University and Science, Gil Medical Center) ;
  • Ahn, Chang Hyeok (Department of Internal Medicine, Gachon University and Science, Gil Medical Center) ;
  • Lee, Sang Pyo (Department of Internal Medicine, Gachon University and Science, Gil Medical Center) ;
  • Park, Jeong Woong (Department of Internal Medicine, Gachon University and Science, Gil Medical Center) ;
  • Jeong, Sung Hwan (Department of Internal Medicine, Gachon University and Science, Gil Medical Center)
  • 전수연 (가천의과대학교 길병원 내과) ;
  • 김유진 (가천의과대학교 길병원 내과) ;
  • 경선영 (가천의과대학교 길병원 내과) ;
  • 안창혁 (가천의과대학교 길병원 내과) ;
  • 이상표 (가천의과대학교 길병원 내과) ;
  • 박정웅 (가천의과대학교 길병원 내과) ;
  • 정성환 (가천의과대학교 길병원 내과)
  • Received : 2007.04.20
  • Accepted : 2007.05.31
  • Published : 2007.06.30
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Abstract

Background: Postoperative pulmonary complications are important problems that prolong the length of the hospital stay and increase patient mortality. However, our knowledge of the postoperative factors that increase the risk of these complications is less than complete. Methods: We conducted a prospective study to determine the risk factors for postoperative pulmonary complications. A total of 199 patients were referred to the Pulmonology Department for preoperative pulmonary evaluation. We reviewed the perioperative variables according to the National Surgical Quality Improvement Program (NSQIP). Postoperatively, we collected data on the occurrence of postoperative pulmonary complications and we evaluated the relationship between the perioperative variables and outcomes. Results: Twenty two patients (11%) had pulmonary complications; 6 had respiratory failure, 4 had pneumonia, 13 had pleural effusion and, 2 had atelectasis. Five variables were statistically significantly associated with pulmonary complications on the bivariate analyses. Multiple logistic regression analyses revealed that three of these variables were independently associated with an increased risk of pulmonary complications; a high cardiac risk index (OR 16.5, p=0.002), emergency surgery (OR 10.3, p=0.017), and thoracic/abdominal surgery (OR 3.8, p=0.047). Conclusion: The risk factors for postoperative pulmonary complications are a high cardiac risk index, emergency surgery and thoracic/abdominal surgery.

연구 목적 및 방법: 수술 후 폐 합병증은 심장 합병증보다 흔하고 술 후 입원기간 연장 및 사망률을 높이는 중요한 합병증이다. 최근 NSQIP에서 수술 후 중요한 폐 합병증인 폐렴과 호흡 부전의 위험 인자를 제시하였으나, 복잡하고 폐기능이나 동맥혈 가스 분석 같은 기본적인 검사 소견은 고려되지 않은 면이 있다. 또한 국내 연구에서는 수술 후 폐 합병증의 위험 인자가 명확치 않다. 이에 전향적 연구로 수술 후 폐 합병증의 위험 인자를 알아보고자 하였다. 가천의대 길병원에서 호흡기내과로 의뢰된 환자 199명을 대상으로 수술 후 폐 합병증(폐렴, 호흡 부전, 무기폐, 흉수)이 생긴 환자군과 그렇지 않은 군의 위험 인자를 비교하였다. 결 과: 22명(11.1%)에서 수술 후 폐 합병증이 발생하였고, 흉수(13명), 호흡 부전(6명), 폐렴(4명), 무기폐(2명) 순이었다. 단변량 분석에서 폐 합병증의 유의한 위험 인자는 높은 cardiac risk index, 수술 전 후 nasogastric tube 사용, 흉부/상복부 수술, 3시간 이상의 마취 시간, 술 전 11.0 g/dL 이하의 헤모글로빈으로 나타났으며, 다변량 로지스틱 회귀 분석 상 독립적인 위험 인자는 응급 수술(OR 10.306, 95% CI=1.508-70.438, p=0.017), 높은 심장 위험도(OR 16.454, 95% CI=2.720-99.521, p=0.002), 수술 종류(OR 3.814, 95% CI=1.016-14.313, p=0.047)로 나타났다.

Keywords

References

  1. Wiener-Kronish JP, Albert RK. Chapter 26. Preoperative evaluation, In: Mason R J, Broaddus VC, Murray JF, Nadel JA, editors. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadel- phia: Elsevier Inc.; 2005. p. 781-94
  2. Smetana my. Preoperative pulmonary evaluation, N Engl J Med 1999;340:937-44 https://doi.org/10.1056/NEJM199903253401207
  3. Epstein SK, Faling LJ, Daly BD, Celli BR. Predicting complications after pulmonary resection: preoperative exercise testing vs a multifactorial cardiopulmonary risk index. Chest 1993;104:694-700 https://doi.org/10.1378/chest.104.3.694
  4. Arozullah AM, Daley J, Henderson WG, Khuri SF, Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac sugery. The National Veterans Admistration Surgical Quality Improvement Program. Ann Surg 2000;232: 242-53 https://doi.org/10.1097/00000658-200008000-00015
  5. Arozullah AM, Khuri, SF, Henderson WG, Daley J; Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 2001;135:847-57 https://doi.org/10.7326/0003-4819-135-10-200111200-00005
  6. McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med 2005;171:514-7 https://doi.org/10.1164/rccm.200408-1069OC
  7. Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest 1996;110:744-50 https://doi.org/10.1378/chest.110.3.744
  8. Kim JH, Kim MH, Kim DS. A prospective controlled study about the effect of incentive spirometer on the postoperative pulmonary complications. Korean J Intern Med 1986;31:27-37
  9. Kim MK, Kwon J, Lee CT, Cho SH, Han SG, Shim YS, et al. Clinical significance of FEV1.O to predict postoperative pulmonary complications. Tuberc Respir Dis 1989;36:333-40
  10. Park JW, Jeong SW, Nam GH, Suh GY, Kim HC, Chung MP, et al. Preoperative evaluation for the prediction of postoperative mortality and morbidity in lung cancer candidates with impaired lung function. Tuberc Respir Dis 2000;48:14-23 https://doi.org/10.4046/trd.2000.48.1.14
  11. Ryu YJ, Park JY, Baik SJ, Lee JH, Cheon EM, Chang JH. Incidence and predictions of postoperative pulmonary complications after nonthoracic surgery in patients of 65 years old or more. Korean J Med 2004;67:65-72
  12. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Circulation 2002;105:1257-67
  13. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in nonthoracic surgical procedures. N Engl J Med 1977;297:845-50 https://doi.org/10.1056/NEJM197710202971601
  14. Gerson MC, Hurst JM Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990;88:101-7 https://doi.org/10.1016/0002-9343(90)90456-N