Revista da Associacao Medica Brasileira (1992) · 2002
[Index for a pulmonary postoperative complication after upper abdominal surgery: a validation study].
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Filardo Flavia De Almeida, Faresin Sonia Maria, Fernandes Ana Luisa Godoy
Аннотация
OBJECTIVE: To validate a previous prognostic index (Pereira et al.) to postoperative pulmonary complication in elective upper abdominal surgery, and observe the risk factor for mortality in this population.
METHODS: 283 patients were followed from pre to postoperative period. They were followed in a protocol including a clinical questionnaire, physical examination, thoracic radiogram and spirometry at pre operative period. The main variables measured were: clinical and functional subjects characteristics at pre operative, type of surgery, duration of surgery, time spent in intensive care unit and hospitalization and the occurrence of pulmonary complication.
RESULTS: 69 patients had pulmonary complications (24.4%), in 87 events registered. These occurred because some patients had more than one complication. Pneumonia was the most freqüent event 34% (30/87) followed by atelectasis 24% (21/87), bronchoconstriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). The multiple logistic regression (MLR) showed the association between age above 56 years old (p = 0.0039); DS > 210 (p = 0.0044) and previous chronic pneumopathy (p = 0.0257) and postoperative pulmonary complication. The frequency of postoperative pulmonary complication observed in each categorical classis based on previous index (Pereira equation) did not differ statistically from the prognostic rate calculated, showing the validity of the prognostic index. When FEV1/FVC was included in MLR, the patients with VEF1/FVC<70% and DS> 210 minutes showed a statistically lower number of pulmonary postoperative compared with estimated by the previous Pereira index. The mortality analyses showed significant association with comorbidity, number of days in care unit and postoperative pulmonary complication, however in the MLR only postoperative pulmonary complication had a significant association with death (p = 0.003).
CONCLUSIONS: The index based on Pereira equation is valid to estimate the prognosis of postoperative pulmonary complication after elective upper abdominal surgery. Age higher 56 years old, duration of surgery more than 210 minutes and pneumopathy are important markers of postoperative pulmonary complication. The only significant marker for mortality was the post operative pulmonary complication.
METHODS: 283 patients were followed from pre to postoperative period. They were followed in a protocol including a clinical questionnaire, physical examination, thoracic radiogram and spirometry at pre operative period. The main variables measured were: clinical and functional subjects characteristics at pre operative, type of surgery, duration of surgery, time spent in intensive care unit and hospitalization and the occurrence of pulmonary complication.
RESULTS: 69 patients had pulmonary complications (24.4%), in 87 events registered. These occurred because some patients had more than one complication. Pneumonia was the most freqüent event 34% (30/87) followed by atelectasis 24% (21/87), bronchoconstriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). The multiple logistic regression (MLR) showed the association between age above 56 years old (p = 0.0039); DS > 210 (p = 0.0044) and previous chronic pneumopathy (p = 0.0257) and postoperative pulmonary complication. The frequency of postoperative pulmonary complication observed in each categorical classis based on previous index (Pereira equation) did not differ statistically from the prognostic rate calculated, showing the validity of the prognostic index. When FEV1/FVC was included in MLR, the patients with VEF1/FVC<70% and DS> 210 minutes showed a statistically lower number of pulmonary postoperative compared with estimated by the previous Pereira index. The mortality analyses showed significant association with comorbidity, number of days in care unit and postoperative pulmonary complication, however in the MLR only postoperative pulmonary complication had a significant association with death (p = 0.003).
CONCLUSIONS: The index based on Pereira equation is valid to estimate the prognosis of postoperative pulmonary complication after elective upper abdominal surgery. Age higher 56 years old, duration of surgery more than 210 minutes and pneumopathy are important markers of postoperative pulmonary complication. The only significant marker for mortality was the post operative pulmonary complication.