Risk Factors for Postoperative Pulmonary Complications After Major Thoracic Surgery.

Abstract

Background

Postoperative pulmonary complications are among the most important causes of morbidity after major thoracic surgery. They contribute to prolonged hospitalization, increased intensive care utilization, delayed recovery, and higher postoperative mortality. Identification of perioperative risk factors is essential for early risk stratification and optimization of surgical outcomes. Thoracic surgery series consistently describe pulmonary complications as a major driver of longer hospital stay and worse recovery.

Objectives

To determine the risk factors for postoperative pulmonary complications after major thoracic surgery and to assess their impact on hospital stay, intensive care unit admission, and mortality.

Methodology

This retrospective analytical study was conducted at Department of Thoracic Surgery Unit, Lady Reading Hospital  Medical Teaching Institution, Peshawar from jan 2019 to jan 2020. A total of 120 patients who underwent major thoracic surgery during the study period were included. Demographic characteristics, smoking history, comorbidities, pulmonary function, type of surgery, operative duration, postoperative pulmonary complications, hospital stay, ICU admission, and mortality were recorded using a structured data collection form. Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The chi-square test, independent t-test, and logistic regression analysis were used where appropriate. A p-value of less than 0.05 was considered statistically significant.

Results

A total of 120 patients were included in the study. The mean age of the patients was 57.3 ± 12.1 years, and males constituted 61.7% of the study population. Postoperative pulmonary complications occurred in 32 patients (26.7%). The most common complications were pneumonia in 12 patients (10.0%), atelectasis in 10 patients (8.3%), prolonged ventilatory support in 6 patients (5.0%), and respiratory failure in 5 patients (4.2%). Complications were more frequent in older patients, smokers, patients with chronic obstructive pulmonary disease, reduced preoperative FEV1, higher ASA grade, and prolonged operative duration. Patients who developed postoperative pulmonary complications had a significantly longer hospital stay compared with those without complications (12.9 ± 4.5 days vs 7.2 ± 2.8 days, p = 0.01). ICU admission was required in 22 patients (18.3%), while overall postoperative mortality was 4 patients (3.3%).

Conclusion

Postoperative pulmonary complications remain frequent after major thoracic surgery and are associated with prolonged hospital stay and increased postoperative morbidity. Advanced age, smoking, chronic obstructive pulmonary disease, reduced pulmonary function, higher ASA grade, and longer operative duration were important risk factors. Early recognition of high-risk patients may improve perioperative planning and postoperative outcomes.