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 New flexible, transparent, wearable biopatch, improves cellular observation, drug delivery
12.11.2018 | Purdue University

nachricht Exosomes 'swarm' to protect against bacteria inhaled through the nose
12.11.2018 | Massachusetts Eye and Ear Infirmary

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: A Leap Into Quantum Technology

Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.

In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...

Im Focus: Research icebreaker Polarstern begins the Antarctic season

What does it look like below the ice shelf of the calved massive iceberg A68?

On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.

Im Focus: Penn engineers develop ultrathin, ultralight 'nanocardboard'

When choosing materials to make something, trade-offs need to be made between a host of properties, such as thickness, stiffness and weight. Depending on the application in question, finding just the right balance is the difference between success and failure

Now, a team of Penn Engineers has demonstrated a new material they call "nanocardboard," an ultrathin equivalent of corrugated paper cardboard. A square...

Im Focus: Coping with errors in the quantum age

Physicists at ETH Zurich demonstrate how errors that occur during the manipulation of quantum system can be monitored and corrected on the fly

The field of quantum computation has seen tremendous progress in recent years. Bit by bit, quantum devices start to challenge conventional computers, at least...

Im Focus: Nanorobots propel through the eye

Scientists developed specially coated nanometer-sized vehicles that can be actively moved through dense tissue like the vitreous of the eye. So far, the transport of nano-vehicles has only been demonstrated in model systems or biological fluids, but not in real tissue. The work was published in the journal Science Advances and constitutes one step further towards nanorobots becoming minimally-invasive tools for precisely delivering medicine to where it is needed.

Researchers of the “Micro, Nano and Molecular Systems” Lab at the Max Planck Institute for Intelligent Systems in Stuttgart, together with an international...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

“3rd Conference on Laser Polishing – LaP 2018” Attracts International Experts and Users

09.11.2018 | Event News

On the brain’s ability to find the right direction

06.11.2018 | Event News

European Space Talks: Weltraumschrott – eine Gefahr für die Gesellschaft?

23.10.2018 | Event News

 
Latest News

In focus: Peptides, the “little brothers and sisters” of proteins

12.11.2018 | Life Sciences

Materials scientist creates fabric alternative to batteries for wearable devices

12.11.2018 | Materials Sciences

A two-atom quantum duet

12.11.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>