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Silva Y1, Place C1, Ludkin A1, Li F1
1Concord Repatriation General Hospital, Physiotherapy, Concord, Australia
Background: Post-operative pulmonary complications are the most serious negative outcomes after after upper abdominal surgery. Early mobilisation has shown to reduce the risk of developing post-operative pulmonary complications.
Purpose: Identify the incidences and factors contributing to post-operative pulmonary complications in an abdominal surgical cohort who are mobilised early.
Methods:
Design: Retrospective observational study.
Participants: Two hundred and nineteen participants who had undergone abdominal surgery and had needed physiotherapy treatment between March -December 2017 at Concord Repatriation General Hospital, Sydney.
Outcome measures: Seven point Melbourne group scale (post-operative pulmonary complications incidence) in the first seven days and details of physiotherapy in regards to early mobilisation in the immediate post operative period.
Results: The incidence of post-operative pulmonary complications was 13.7% (30 participants). Participants who did not develop post-operative pulmonary complications had a mean age of 65 ±SD 16.12 years, mean anaesthetic duration of 4.6±SD 1.87 hours (range 2-14), mean body mass index of 28.9±SD 11.84, mean american society of anaesthesiologists score of 2.4±SD 0.7 and mean length of stay of 10.3±SD 9.71 days (range 3-57). This group had 14.4% with respiratory co-morbidities, 12.2% with cardiac co-morbidities, 7.9% with current infection/sepsis, 35% with an open incision and 3% with post operative non respiratory complications. Participants who developed post-operative pulmonary complications had a mean age of 71.3±SD 13.61, mean anaesthetic duration of 5.7±SD 2.67 hours (range 2-15), mean body mass index of 27.2±SD 4.32 and mean length of stay of 33.6±SD 31.63 days (5-108). This group had 23.3% with respiratory co-morbidities, 30% wih cardiac co-morbidities, 16.7% with current infection/sepsis, 76.7% with an open incision and 36% with post operative non respiratory complications. In the post-operative pulmonary complication group 46% could not be mobilised due to being medically unstable compared to 18.6% in the non post-operative pulmonary complication group.
Conclusion(s): Despite early mobilisation it is difficult to reduce risk of post-operative pulmonary complications in high risk cohort undergoing abdominal surgery. Increased age, anaesthetic time, current infection/sepsis, respiratory / cardiac co-morbidities and open incision appear to be the major risk factors to developing post-operative pulmonary complications. There is a greater chance of developing post-operative pulmonary complications when the participant has a combination of risk factors.
Implications: Better understanding of the different risk factors which affect the development of post-operative pulmonary complications after abdominal surgery. In the presence of multiple risk factors may warrant more intense and frequent physiotherapy in addition to mobility.
Keywords: Post-operative pulmonary complication, Abdominal surgery, Risk
Funding acknowledgements: nil
Purpose: Identify the incidences and factors contributing to post-operative pulmonary complications in an abdominal surgical cohort who are mobilised early.
Methods:
Design: Retrospective observational study.
Participants: Two hundred and nineteen participants who had undergone abdominal surgery and had needed physiotherapy treatment between March -December 2017 at Concord Repatriation General Hospital, Sydney.
Outcome measures: Seven point Melbourne group scale (post-operative pulmonary complications incidence) in the first seven days and details of physiotherapy in regards to early mobilisation in the immediate post operative period.
Results: The incidence of post-operative pulmonary complications was 13.7% (30 participants). Participants who did not develop post-operative pulmonary complications had a mean age of 65 ±SD 16.12 years, mean anaesthetic duration of 4.6±SD 1.87 hours (range 2-14), mean body mass index of 28.9±SD 11.84, mean american society of anaesthesiologists score of 2.4±SD 0.7 and mean length of stay of 10.3±SD 9.71 days (range 3-57). This group had 14.4% with respiratory co-morbidities, 12.2% with cardiac co-morbidities, 7.9% with current infection/sepsis, 35% with an open incision and 3% with post operative non respiratory complications. Participants who developed post-operative pulmonary complications had a mean age of 71.3±SD 13.61, mean anaesthetic duration of 5.7±SD 2.67 hours (range 2-15), mean body mass index of 27.2±SD 4.32 and mean length of stay of 33.6±SD 31.63 days (5-108). This group had 23.3% with respiratory co-morbidities, 30% wih cardiac co-morbidities, 16.7% with current infection/sepsis, 76.7% with an open incision and 36% with post operative non respiratory complications. In the post-operative pulmonary complication group 46% could not be mobilised due to being medically unstable compared to 18.6% in the non post-operative pulmonary complication group.
Conclusion(s): Despite early mobilisation it is difficult to reduce risk of post-operative pulmonary complications in high risk cohort undergoing abdominal surgery. Increased age, anaesthetic time, current infection/sepsis, respiratory / cardiac co-morbidities and open incision appear to be the major risk factors to developing post-operative pulmonary complications. There is a greater chance of developing post-operative pulmonary complications when the participant has a combination of risk factors.
Implications: Better understanding of the different risk factors which affect the development of post-operative pulmonary complications after abdominal surgery. In the presence of multiple risk factors may warrant more intense and frequent physiotherapy in addition to mobility.
Keywords: Post-operative pulmonary complication, Abdominal surgery, Risk
Funding acknowledgements: nil
Topic: Cardiorespiratory
Ethics approval required: Yes
Institution: concord Repatriation General Hospital
Ethics committee: Sydney Local Health District Research Office
Ethics number: SSA/17/CRGH/65
All authors, affiliations and abstracts have been published as submitted.
