AURORA, Colo. – Researchers at the University
of Colorado Anschutz Medical Campus, along
with seven other major institutions, have found that even mild postoperative
pulmonary complications (PPCs) are significantly associated with increased
death within the first week after surgery.
The study, which appeared online today in the journal JAMA
Surgery, examined 1,202 patients who underwent abdominal, orthopedic,
neurological and other procedures under general anesthesia for at least two
“We found that patients with one or more PPCs, even
mild, had significantly increased intensive care unit admission, ICU/hospital
length of stay and early postoperative mortality,” said Ana
Fernandez-Bustamante, MD, PhD, associate professor of anesthesiology at the University
of Colorado School of Medicine. She and Marcos Francisco
Vidal Melo, MD, PhD, associate professor at the Massachusetts General Hospital,
Harvard University, are the lead authors of the article.
Current estimates suggest that there are over a
million PPCs each year in the U.S. resulting in 46,200 deaths and 4.8 million
hospitalizations days. Most of these PPCs are considered mild (i.e. needing
prolonged supplemental oxygen), difficult to measure and often ignored in
Fernandez-Bustamante and her colleagues, including
Karsten Bartels, MD, assistant professor of anesthesiology at CU Anschutz, set
out to understand these PPCs better and how to address them.
They studied patients classified as “physical status
3” by the American Society of Anesthesiologists, meaning they suffered severe
systemic disease. The patients underwent prolonged, non-cardiac or thoracic
surgery with general anesthesia and mechanical ventilation.
A third of them developed one or more PPCs after
surgery. These patients were often older with hypertension, cancer or chronic
obstructive pulmonary disease.
Severe complications were rare. The most common
complication was simply requiring oxygen for longer than 24 hours after the
operation. That was followed by atelectasis (or portions of the lungs being
But even these relatively mild complications were
associated with significantly increased hospital stay, admission to the ICU or
mortality within the first week after surgery.
And this was observed at seven large American academic
“This tells us that care could be improved,”
Fernandez-Bustamante said. “If we could understand better and prevent mild PPCs
we could improve the recovery of thousands of patients.”
Doctors know that giving patients too many fluids or
too big breaths during anesthesia can cause pulmonary problems afterwards.
Fernandez-Bustamante said that paying more attention
to preventing atelectasis, for example, before, during and after surgery, could
reduce some of them, improve oxygenation and prevent the need of oxygen therapy
and hospital stay. She noted that physicians must also optimize fluids and pain
control, and minimize blood loss during operations to prevent PPCs. Doing all
of this, she said, could improve patient outcomes and result in shorter
“Surgeons, anesthesiologists, nurses, respiratory
therapists, and others, must collaborate better to make this successful. And of
course patients need to know they play a critical role in their own recovery.
We must work with them closely before, during and after surgery,”
Fernandez-Bustamante said. “If we want patients to have less pulmonary
complications, we need a truly comprehensive approach to this problem.”
The study co-authors include Karsten Bartels, MD, of
the University of Colorado School of Medicine and statisticians from the Adult
and Children Outcomes Research and Delivery Systems, University of Colorado
School of Medicine. The other institutions that took part in the study are Massachusetts
General Hospital (Boston, MA); Brigham and Women’s Hospital (Boston, MA); Mayo
Clinic (Rochester, MN); Beth Israel Deaconess Medical Center (Boston, MA);
University of Miami (Palmetto Bay, FL); and University of California San
Francisco (San Francisco, CA).