Original Articles

Journal of General Internal Medicine

, Volume 10, Issue 12, pp 671-678

First online:

Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery

  • Valerie A. LawrenceAffiliated withthe Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science Centerthe Division of General Medicine, University of Texas Health Science Center
  • , Susan G. HilsenbeckAffiliated withDivision of Oncology, University of Texas Health Science Center
  • , Cynthia D. MulrowAffiliated withthe Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science Centerthe Division of General Medicine, University of Texas Health Science Center
  • , Rahul DhandaAffiliated withthe Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science Center
  • , Joan SappAffiliated withthe Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science Center
  • , Carey P. PageAffiliated withthe Audie L. Murphy Memorial Veterans Hospital, University of Texas Health Science CenterDepartment of Medicine, and the Department of Surgery, University of Texas Health Science Center

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Abstract

OBJECTIVE: Internists frequently evaluate preoperative cardiopulmonary risk and comanage cardiac and pulmonary complications, but the comparative incidence and clinical importance of these complications are not clearly delineated. This study evaluated incidence and length of stay for both cardiac and pulmonary complications after elective laparotomy.

DESIGN: Nested case-control.

SETTING: University-affiliated Department of Veterans Affairs Hospital.

PATIENTS: Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991.

MEASUREMENT AND MAIN RESULTS: Strategy for ascertainment and verification of complications was systematic and explicit. The charts of all 116 patients identified by the registry as having complications and 412 (19%) randomly selected from 2,175 remaining patients were reviewed to verify presence or absence of cardiac or pulmonary complications, using explicit criteria and independent abstraction of pre- and postoperative components of charts. From these 528 validated cases and controls (23% of the cohort), 96 cases and 96 controls were matched by operation type and age within ten years. Hospital and intensive care unit stays were significantly longer (p<0.0001) for the cases than for the controls (24.1 vs 10.3 and 5.8 vs 1.5 days, respectively). All 19 deaths occurred among the cases. Among the cases, pulmonary complications occurred significantly more often than cardiac complications (p<0.00001) and were associated with significantly longer hospital stays (22.7 vs 10.4 days, p=0.001). Combined cardiopulmonary complications occurred among 26% of the cases. Misclassification-corrected incidence rates for the entire cohort were 9.6% (95% CI 7.2–12.0) for pulmonary and 5.7% (95% CI 3.8–7.7) for cardiac complications.

CONCLUSIONS: For noncardiac surgery, previous research has focused on cardiac risk. In this study, pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment.

Key words

preoperative care surgery/operative pulmonary complications cardiac complications