Multivariate analysis of perioperative risk factors associated with postoperative pulmonary complications in elder patients undergoing upper abdominal surgery

Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications(POPC) in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients(age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010) was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients(45.6%),and the most common complication was pneumonia(20 cases),followed by atelectasis(18 cases),tracheobronchitis or acute exacerbations of chronic bronchitis(17 cases),bronchospasm(15 cases),acute respiratory failure(5 cases) and pulmonary embolism(2 cases).Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity(FEV1/FVC) and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.