Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators

Ana Fernandez-Bustamante, Gyorgy Frendl, Juraj Sprung, Daryl J Kor, Bala Subramaniam, Ricardo Martinez Ruiz, Jae Woo Lee, William G. Henderson, Angela Moss, Nitin Mehdiratta, Megan M. Colwell, Karsten Bartels, Kerstin Kolodzie, Jadelis Giquel, Marcos Francisco Vidal Melo

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95%CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95%CI, 1.67-3.89; and age [in years]: OR, 1.03, 95%CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95%CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95%CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95%CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95%CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95%CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

Original languageEnglish (US)
Pages (from-to)157-166
Number of pages10
JournalJAMA Surgery
Volume152
Issue number2
DOIs
StatePublished - Feb 1 2017

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Multicenter Studies
Length of Stay
Research Personnel
Lung
Mortality
Odds Ratio
Research
Intensive Care Units
Pulmonary Atelectasis
Oxygen
Orthopedic Procedures
Respiratory Therapy
Tidal Volume
Colloids
Hospital Mortality
Artificial Respiration
Respiratory Insufficiency
General Anesthesia
Observational Studies
Ventilation

ASJC Scopus subject areas

  • Surgery

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Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery : A multicenter study by the perioperative research network investigators. / Fernandez-Bustamante, Ana; Frendl, Gyorgy; Sprung, Juraj; Kor, Daryl J; Subramaniam, Bala; Ruiz, Ricardo Martinez; Lee, Jae Woo; Henderson, William G.; Moss, Angela; Mehdiratta, Nitin; Colwell, Megan M.; Bartels, Karsten; Kolodzie, Kerstin; Giquel, Jadelis; Melo, Marcos Francisco Vidal.

In: JAMA Surgery, Vol. 152, No. 2, 01.02.2017, p. 157-166.

Research output: Contribution to journalArticle

Fernandez-Bustamante, A, Frendl, G, Sprung, J, Kor, DJ, Subramaniam, B, Ruiz, RM, Lee, JW, Henderson, WG, Moss, A, Mehdiratta, N, Colwell, MM, Bartels, K, Kolodzie, K, Giquel, J & Melo, MFV 2017, 'Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators', JAMA Surgery, vol. 152, no. 2, pp. 157-166. https://doi.org/10.1001/jamasurg.2016.4065
Fernandez-Bustamante, Ana ; Frendl, Gyorgy ; Sprung, Juraj ; Kor, Daryl J ; Subramaniam, Bala ; Ruiz, Ricardo Martinez ; Lee, Jae Woo ; Henderson, William G. ; Moss, Angela ; Mehdiratta, Nitin ; Colwell, Megan M. ; Bartels, Karsten ; Kolodzie, Kerstin ; Giquel, Jadelis ; Melo, Marcos Francisco Vidal. / Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery : A multicenter study by the perioperative research network investigators. In: JAMA Surgery. 2017 ; Vol. 152, No. 2. pp. 157-166.
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abstract = "Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9{\%}) were men. At least 1 PPC occurred in 401 patients (33.4{\%}), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6{\%}) and atelectasis (n = 206; 17.1{\%}). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95{\%}CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95{\%}CI, 1.67-3.89; and age [in years]: OR, 1.03, 95{\%}CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95{\%}CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95{\%}CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95{\%}CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95{\%}CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95{\%}CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.",
author = "Ana Fernandez-Bustamante and Gyorgy Frendl and Juraj Sprung and Kor, {Daryl J} and Bala Subramaniam and Ruiz, {Ricardo Martinez} and Lee, {Jae Woo} and Henderson, {William G.} and Angela Moss and Nitin Mehdiratta and Colwell, {Megan M.} and Karsten Bartels and Kerstin Kolodzie and Jadelis Giquel and Melo, {Marcos Francisco Vidal}",
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TY - JOUR

T1 - Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery

T2 - A multicenter study by the perioperative research network investigators

AU - Fernandez-Bustamante, Ana

AU - Frendl, Gyorgy

AU - Sprung, Juraj

AU - Kor, Daryl J

AU - Subramaniam, Bala

AU - Ruiz, Ricardo Martinez

AU - Lee, Jae Woo

AU - Henderson, William G.

AU - Moss, Angela

AU - Mehdiratta, Nitin

AU - Colwell, Megan M.

AU - Bartels, Karsten

AU - Kolodzie, Kerstin

AU - Giquel, Jadelis

AU - Melo, Marcos Francisco Vidal

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95%CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95%CI, 1.67-3.89; and age [in years]: OR, 1.03, 95%CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95%CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95%CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95%CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95%CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95%CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

AB - Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95%CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95%CI, 1.67-3.89; and age [in years]: OR, 1.03, 95%CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95%CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95%CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95%CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95%CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95%CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

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