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VOLUME 18 , ISSUE 6 ( June, 2014 ) > List of Articles


Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

Som Chandra, Garima Aggarwal

Keywords : Hepatic resection, postoperative pulmonary complications, posthepatic resection complications

Citation Information : Chandra S, Aggarwal G. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit. Indian J Crit Care Med 2014; 18 (6):358-362.

DOI: 10.4103/0972-5229.133882

License: CC BY-ND 3.0

Published Online: 01-01-2006

Copyright Statement:  Copyright © 2014; The Author(s).


Background: Postoperative pulmonary complication (PPC) is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU). Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group) against the patients who did not (no-PPC group). Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8%) followed by atelectasis in 8 (28.5%) and pleural effusion in 3 (10.7%). Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%), 21 patients were smokers (75%) and 8 patients (28.5%) had chronic obstructive pulmonary disease (COPD). The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days). Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc.) were independent predictive variables for the development of PPC.

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  1. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: Analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397-406.
  2. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg 2006;243:373-9.
  3. House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: Trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg 2010;210:744-52, 752-5.
  4. Csikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg 2008;12:1534-9.
  5. Capussotti L, Polastri R. Operative risks of major hepatic resections. Hepatogastroenterology 1998;45:184-90.
  6. O′Donohue WJ Jr. Postoperative pulmonary complications. When are preventive and therapeutic measures necessary? Postgrad Med 1992;91:167-70, 173-5.
  7. Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung 1995;24:94-115.
  8. Brooks-Brunn JA. Postoperative atelectasis and pneumonia: Risk factors. Am J Crit Care 1995;4:340-9.
  9. Afessa B, Gay PC, Plevak DJ, Swensen SJ, Patel HG, Krowka MJ. Pulmonary complications of orthotopic liver transplantation. Mayo Clin Proc 1993;68:427-34.
  10. Weingarten TN, Kor DJ, Gali B, Sprung J. Predicting postoperative pulmonary complications in high-risk populations. Curr Opin Anaesthesiol 2013;26:116-25.
  11. Smetana GW, Lawrence VA, Cornell JE, American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: Systematic review for the American College of Physicians. Ann Intern Med 2006;144:581-95.
  12. Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: A systematic review of blinded studies. Am J Med 2002;112:219-25.
  13. McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med 2005;171:514-7.
  14. Montravers P, Veber B, Auboyer C, Dupont H, Gauzit R, Korinek AM, et al. Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: Results of the Eole study. Crit Care Med 2002;30:368-75.
  15. Platell C, Hall JC. Atelectasis after abdominal surgery. J Am Coll Surg 1997;185:584-92.
  16. Thasler WE, Bein T, Jauch KW. Perioperative effects of hepatic resection surgery on hemodynamics, pulmonary fluid balance, and indocyanine green clearance. Langenbecks Arch Surg 2002;387:271-5.
  17. Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 1995;10:671-8.
  18. Iwamoto K, Ichiyama S, Shimokata K, Nakashima N. Postoperative pneumonia in elderly patients: Incidence and mortality in comparison with younger patients. Intern Med 1993;32:274-7.
  19. Koperna T, Kisser M, Schulz F. Hepatic resection in the elderly. World J Surg 1998;22:406-12.
  20. Hawn MT, Houston TK, Campagna EJ, Graham LA, Singh J, Bishop M, et al. The attributable risk of smoking on surgical complications. Ann Surg 2011;254:914-20.
  21. Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol 2004;88:71-7.
  22. Gupta H, Ramanan B, Gupta PK, Fang X, Polich A, Modrykamien A, et al. Impact of COPD on postoperative outcomes: Results from a national database. Chest 2013;143:1599-606.
  23. Ephgrave KS, Kleiman-Wexler R, Pfaller M, Booth B, Werkmeister L, Young S. Postoperative pneumonia: A prospective study of risk factors and morbidity. Surgery 1993;114:815-9.
  24. Vamvakas EC, Carven JH. Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: Effect of the length of storage of transfused red cells. Transfusion 1999;39:701-10.
  25. Vamvakas EC, Carven JH. Exposure to allogeneic plasma and risk of postoperative pneumonia and/or wound infection in coronary artery bypass graft surgery. Transfusion 2002;42:107-13.
  26. Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 2011;39:2163-72.
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