Predictors of postoperative pulmonary complications following abdominal surgery

Study objective: To determine how risk factors could be combined to best predict the development of a postoperative pulmonary complication (PPC) following abdominal surgery. Design: Prospective model-building study. Logistic regression models were developed using significant risk factors identified in the univariate analysis. Setting: Four midwestern hospitals. Patients: Convenience sample of 400 patients who underwent abdominal surgical procedures between January 1993 and August 1995. Measurements and results: Multicriteria outcome for postoperative pulmonary complication used to collectively assess atelectasis and pneumonia. Twenty-three risk factors were assessed. Six risk factors were identified as independent by logistic regression: age greater than or equal to 60 years (adjusted odds ratio [Adj OR], 1.89); impaired preoperative cognitive function (Adj OR, 5.93); smoking history within the past 8 weeks (Adj OR, 2.27); body mass index: greater than or equal to 27 (Adj OR, 2.82); history of cancer (Adj OR, 2.23); and incision site-upper abdominal or both upper/lower abdominal incision (Adj OR 2.30). Conclusions: These results provide a framework for identifying patients at risk of developing a PPC following abdominal surgery. A reliable and valid risk index could be used clinically to guide preoperative and postoperative pulmonary care and target limited resources for patients at risk.