Post-Operative Pulmonary Complication
Original Editor - Ronald Yip
Post-operative pulmonary complication is an umbrella term of adverse changes to the respiratory system occurring immediately after surgery. The most common presentations include an altered function of respiratory muscles, reduced lung volume, respiratory failure and atelectasis.
Incidence and Impact
Up to 23% of patient underwent major surgery would suffer from PPCs. In fact, the incidence of PPCs is more common than cardiac complication. With people who sustain PPCs, 14% to 30% die within 30 days after a major surgery compared to only 0.2% to 3% of patient who does not have PPCs.  In terms of morbidity, PPCs, increases the length of hospital stay by 13 - 17 days.
List of PPCs
- Respiratory infection
- Respiratory failure
- Pleural effusion
- Aspiration pneumonia
- Acute respiratory distress syndrome
There is a range of factors to predict the development of PPCs, which are divided into modifiable and non-modifiable.
- Age - > 60 or 65 years is found to have increased risk.
- Surgery type - Abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, neurosurgery and major vascular surgery are found to have a higher risk than other types of surgery.
- Co-morbidity - Patient with the following conditions has a higher risk in the development of PPCs: Chronic obstructive pulmonary disease, congestive heart failure, chronic liver disease.
- Preoperative anaemia
- General anaesthesia - the use of GA disturbs many aspects of respiratory function, hence increases the risk of patient developing PPCs.
- Low tidal volume - People who have lower tidal volume spontaneously are categorised as a higher risk.
- Neuromuscular blocking drugs
- Nasogastric tube
PPC and Physiotherapy
Physiotherapy services are considered preventative measures in different stages of recovery.
Preoperative aerobic exercise and inspiratory muscle training are recommended to reduce PPCs and LOS in cardiac and abdominal surgery patients. It is found that preoperative IMT reduces postoperative atelectasis and pneumonia.
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