Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New guidelines help clinicians assess risk of post-surgical pulmonary complications

20.04.2006


Pulmonary complications, including pneumonia and respiratory failure, are a common – and dangerous – problem for patients following major surgery. To address this issue, a comprehensive systematic review and meta-analysis in the April 18, 2006 issue of The Annals of Internal Medicine provides clinicians with new guidelines to use prior to surgery in assessing a patient’s risk of developing pulmonary problems postoperatively.



"Independent of surgical complications, such as infections and bleeding, there are three major types of medical risks that accompany major surgery," explains the study’s lead author Gerald W. Smetana, MD, an internist in the division of general medicine and primary care at Beth Israel Deaconess Medical Center (BIDMC) and Associate Professor of Medicine at Harvard Medical School. "These include cardiac risks such as a heart attack, the risk of blood clot formation, and pulmonary risks."

Nearly 30 years ago risk indices and guidelines were developed to assess post-surgical cardiac risks, he adds, but until now, the issue of pulmonary risk factors had not been formally addressed.


"Many physicians will be surprised to learn that we found pulmonary complications to be as prevalent as cardiac complications," says Smetana. The reason, he says, is that patients’ lung volumes are lower following both surgery and the administration of general anesthesia. As a result, small areas of lung become vulnerable to collapse, thereby increasing patients’ chances of developing pneumonia, suffering respiratory failure or experiencing a worsening of existing lung disease, such as emphysema.

Smetana, together with coauthors Valerie Lawrence, MD, and John Cornell, PhD, of the South Texas Veterans Health Care System, performed a systematic review of nearly 1,000 medical studies published between 1980 and 2005 in order to develop the guidelines for the American College of Physicians. After calculating summary estimates of risk, the authors divided their findings into patient-related risk factors and surgery-related risk factors, according to Smetana.

"Among the patient-related risk factors we made several clear observations," he adds. "Most notably, even among otherwise healthy patients, advanced age [over 70] increased a person’s risk of developing pulmonary complications four-fold to six-fold. Given that age is not a risk factor for post-surgical cardiac complications, we were quite surprised by this finding." Other patient-related factors that increased the risk of complications included preexisting emphysema, functional dependence (patients’ inability to care for themselves), congestive heart failure and smoking cigarettes.

Among pulmonary risk factors related to the surgical procedure, he adds, location of the surgical site was of greatest impact.

"The closer the surgery was to the diaphragm – any thoracic, upper abdominal, gallbladder or aortic surgery for example – the greater the risk of complications," notes Smetana. In addition, emergency surgery or surgery lasting more than three hours also increased the likelihood that patients would develop postoperative pulmonary problems.

In an accompanying paper, the authors also evaluated the value of various interventions to reduce the risk of pulmonary complications, and found that two simple treatments that increase lung volume, deep breathing exercises and incentive spirometry, proved to be the most effective strategies.

"We hope that our findings will help doctors provide their patients with a good estimate of pulmonary risk prior to surgery," says Smetana. "In fact, this review points out the importance of the doctor-patient relationship. Medical consultations are extremely important for patients as they prepare for surgery and this provides both doctors and patients with another tool to use in their decision-making processes."

Bonnie Prescott | EurekAlert!
Further information:
http://www.bidmc.harvard.edu

More articles from Health and Medicine:

nachricht How cancer metastasis happens: Researchers reveal a key mechanism
19.01.2018 | Weill Cornell Medicine

nachricht Researchers identify new way to unmask melanoma cells to the immune system
17.01.2018 | Duke University Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Artificial agent designs quantum experiments

On the way to an intelligent laboratory, physicists from Innsbruck and Vienna present an artificial agent that autonomously designs quantum experiments. In initial experiments, the system has independently (re)discovered experimental techniques that are nowadays standard in modern quantum optical laboratories. This shows how machines could play a more creative role in research in the future.

We carry smartphones in our pockets, the streets are dotted with semi-autonomous cars, but in the research laboratory experiments are still being designed by...

Im Focus: Scientists decipher key principle behind reaction of metalloenzymes

So-called pre-distorted states accelerate photochemical reactions too

What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...

Im Focus: The first precise measurement of a single molecule's effective charge

For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.

Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...

Im Focus: Paradigm shift in Paris: Encouraging an holistic view of laser machining

At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.

No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...

Im Focus: Room-temperature multiferroic thin films and their properties

Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.

Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

10th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Münster, 10-11 April 2018

08.01.2018 | Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

 
Latest News

Let the good tubes roll

19.01.2018 | Materials Sciences

How cancer metastasis happens: Researchers reveal a key mechanism

19.01.2018 | Health and Medicine

Meteoritic stardust unlocks timing of supernova dust formation

19.01.2018 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>