DOI: http://dx.doi.org/10.18203/2349-2902.isj20190515

Clinical study of respiratory complications in patients undergoing elective upper abdominal surgery

Praveen C. B., Imran Thariq Ajmal

Abstract


Background: Postoperative pulmonary complication is a major cause of morbidity, mortality, prolonged hospital stay and increased cost of care especially when it involves Upper Abdominal surgery. The predictable changes in lung function include a decrease in vital capacity and functional residual capacity, which are more striking in obese patients and in the supine. Aim is to study the incidence of respiratory complications in patients undergoing elective upper abdominal surgery with identification of risk factors namely Age, Sex, Obesity, Smoking and duration of upper abdominal Surgery for the development of Respiratory complications using a Peak Flow Meter as a bedside predictive test.

Methods: Peak expiratory flow rate (PEFR) measurement daily up to 7 days post-surgery, were noted to monitor the occurrence of postoperative respiratory complications.

Results: The study results according to our study showed that14 (34.1%) male patients out of 41 had postoperative complications as compared to 15 (48.3%) out of 31 female patients. 30.5% patients were obese and had postoperative complications of 9.75%. Overall 40% of smokers had postoperative complications. Postoperatively sub costal incision had complications (41%) in 36 patients, roof top incisions 4 out of 5 (80%) and para-umbilical incisions 3 out of 4 (75%). 80% of the patients who had upper abdominal transverse incisions developed microatelectasis followed by 75% of patients who had par median incisions.

Conclusions: Respiratory complications following elective upper abdominal surgery are influenced by Increasing age and obesity and Smoking affected post-operative pulmonary recovery. Type of incision could also help change the incidence of complications.


Keywords


Abdominal surgery, Pulmonary complications, PEFR, Risk factors

Full Text:

PDF

References


Latimer RG, Dickman M, Day WC, Gunn ML, Schmidt CD. Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis. Am J Surg. 1971 Nov 1;122(5):622-32.

Ali J, Weisel RD, Layug AB, Kripke BJ, Hechtman HB. Consequences of postoperative alterations in respiratory mechanics. Am J Surg. 1974 Sep 1;128(3):376-82.

Heuer HJ, Scanlan Cl. Home care patient assessment, Wilkins’ Clinical Assessment in Respiratory Care.7th Edition, 2013:453-467.

Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest. 1996 Sep 1;110(3):744-50.

Stein M, Cassara EL. Preoperative pulmonary evaluation and therapy for surgery patients. JAMA. 1970 Feb 2;211(5):787-90.

Wightman JA. A prospective survey of the incidence of postoperative pulmonary complications. Br J Surg. 1968 Feb;55(2):85-91.

Lyager S, Wernderg M, Rajani N, Boggild‐Madsen B, Nielsen L, Nielsen HC, Andersen M, Møller J, Silberschmid M. Can postoperative pulmonary conditions be improved by treatment with the Bartlett‐Edwards incentive spirometer after upper abdominal surgery?. Acta Anaesthesiol Scandinavica. 1979 Aug;23(4):312-9.

Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Resp Dis. 1984 Jul;130(1):12-5.

Roukema J A, Erich J carol, Jan G. prins: the prevention of pulmonary compromised after upper abdominal surgery in patients with non-compromised pulmonary status. Arch Surg. 1988;123:30-4.

Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar 1;111(3):564-71.

Mathew JT, D’souza GA, kilpadi AB. Respiratory complications in postoperative patients. J Assoc Physicians India. 1999 Nov; 47(11): 1086-88.

Hamilton WK, Mcdonald JS, Fischer HW, Bethards R. Postoperative respiratory complications. Anesthesiology. 1964 Sep-Oct;25:607-12.

Gould AB. Effect of obesity. On respiratory complications following General Anesthesia. Analg Analgesia. 1962:41:(4):448-52.

Jung R, Wight J, Nusser R, Rosoff L. Comparison of three methods of respiratory care following upper abdominal surgery. Chest. 1980 Jul 1;78(1):31-5.

Chauvin M, Samii K, Schermann JM, Sandouk P. Pharmacology of narcotics administered by the epidural or intrathecal route (author's transl). New Med Press. 1982 Mar;11(13):1003-6.

Thoren, L. The new medical press Postoperative Pulmonary Complications. Acta Chir Scand. 1954 May 5;107(2-3):193-205.

Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991 Apr 1;99(4):923-7.

Ford GT, Whitelaw WA, Rosenal TW, Cruse PJ, Guenter CA. Diaphragm function after upper abdominal surgery in humans. Am Rev Resp Dis. 1983 Apr;127(4):431-6.

Meneely GK, Ferguson J. Pulmonary evaluation and risk in patients Preparing for anesthesia and surgery. JAMA. 1980;95:1074-80.