We initially screened 1106 patients with COPD who underwent preoperative consultations with respiratory physicians and were registered in our institutional, prospectively collected PPC database between March 2014 and January 2015 [14 (link)]. We excluded 64 patients with bronchial asthma, determined by Shin SH and Im Y based on the patients’ medical history with further confirmation by Park HY. Thereafter, we further excluded 623 patients owing to the reasons described in Figure 1 . Finally, 419 patients with COPD who had undergone an elective abdominal surgery (upper abdominal surgery, n = 177; lower abdominal surgery, n = 132; and perineal surgery, n = 110) under isolated general anesthesia were included in this study. Upper abdominal surgery included pancreatectomy, gastrectomy, hepatectomy, cholecystectomy, small bowel resection, and abdominal aortic surgery. Lower abdominal surgery included colectomy, adrenalectomy, nephrectomy, and cystectomy. Perineal surgery included prostatectomy, endourological surgery, ureterostomy, ureteroureterostomy, oophorectomy, salpingo-oophorectomy, salpingectomy, hysterectomy, and uterine myomectomy. All patients underwent a lung expansion maneuver with incentive spirometry during the preoperative and postoperative periods [15 (link)]. Deep inspiration, active coughing, and sputum expectoration were encouraged during the postoperative period.
All preoperative and postoperative data (including the presence or type of PPCs) were already collected by respiratory physicians in the aforementioned PPC database before the start of this study. PPCs were defined as a composite of respiratory failure, pleural effusion, atelectasis, respiratory infection, pneumothorax, and bronchospasm within seven days postoperatively based on previously published articles [13 (link),16 (link)]. In particular, bronchiectasis was assessed by reviewing chest radiographs or high-resolution chest computed tomography scans [17 (link)]. Bronchodilator use was defined as the use of an inhaled short- or long-acting bronchodilator during the perioperative period. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was calculated based on age, blood oxygen saturation, recent respiratory infection, anemia, surgical incision, and surgical duration [16 (link)].
Intraoperative anesthetic variables collected for this study from electronic medical records included intubation difficulty, anesthetic agent use, mechanical ventilation parameters, hemodynamics, fluid therapy use, blood loss, core temperature, airway humidification, vasoactive drug use, and neuromuscular blockade and its reversal. Furthermore, postoperative outcome variables collected from electronic medical records included prolonged mechanical ventilation >24 h, reintubation, length of hospital stay, and postoperative 30- or 90-day mortality. Our institutional review board approved this retrospective study (SMC 2018-11-092, Chairperson Prof. Lee Suk-Koo) and waived the requirement for written informed consent.
All preoperative and postoperative data (including the presence or type of PPCs) were already collected by respiratory physicians in the aforementioned PPC database before the start of this study. PPCs were defined as a composite of respiratory failure, pleural effusion, atelectasis, respiratory infection, pneumothorax, and bronchospasm within seven days postoperatively based on previously published articles [13 (link),16 (link)]. In particular, bronchiectasis was assessed by reviewing chest radiographs or high-resolution chest computed tomography scans [17 (link)]. Bronchodilator use was defined as the use of an inhaled short- or long-acting bronchodilator during the perioperative period. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was calculated based on age, blood oxygen saturation, recent respiratory infection, anemia, surgical incision, and surgical duration [16 (link)].
Intraoperative anesthetic variables collected for this study from electronic medical records included intubation difficulty, anesthetic agent use, mechanical ventilation parameters, hemodynamics, fluid therapy use, blood loss, core temperature, airway humidification, vasoactive drug use, and neuromuscular blockade and its reversal. Furthermore, postoperative outcome variables collected from electronic medical records included prolonged mechanical ventilation >24 h, reintubation, length of hospital stay, and postoperative 30- or 90-day mortality. Our institutional review board approved this retrospective study (SMC 2018-11-092, Chairperson Prof. Lee Suk-Koo) and waived the requirement for written informed consent.
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