Risk prediction models for postoperative pulmonary complications (PPCs) can assist healthcare professionals in assessing the likelihood of PPCs occurring after surgery, thereby supporting rapid decision-making. This study evaluated the merits, limitations, and challenges of these models, focusing on model types, construction methods, performance, and clinical applications. The findings indicate that current risk prediction models for PPCs following lung cancer surgery demonstrate a certain level of predictive effectiveness. However, there are notable deficiencies in study design, clinical implementation, and reporting transparency. Future research should prioritize large-scale, prospective, multi-center studies that utilize multiomics approaches to ensure robust data for accurate predictions, ultimately facilitating clinical translation, adoption, and promotion.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectiveTo determine the predictive value of preoperative systemic immune-inflammatory index (SII) regarding the development of postoperative pulmonary complications (PPCs) after abdominal surgery.MethodsThisretrospective study involved 433 patients undergoing elective abdominal surgery. Logistic regression risk model was used to evaluate the prognostic value of SII. We drew the receiver-operating characteristic (ROC) curve and calculated the area under the ROC curve to compared the predictive ability of SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to- lymphocyte ratio (MLR).ResultsThe independent risk factors of PPCs were preoperative respiratory diseases, preoperative history of chronic liver disease, maintenance of intravenous or inhalation anesthesia, and intraoperative infusion of more colloid (P<0.05). However, SII, PLR, NLR, and MLR did not predict the occurrence of PPCs, and they also did not predict ≥3 grade of PPCs (AUC<0.60, P>0.05).ConclusionsPreoperative SII is not a prognostic biomarker of PPCs occurrence in patients undergoing elective abdominal surgery. Other biomarkers, such as PLR, NLR, and MLR, also have no predictive value for the PPCs in these patients.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.
Objective To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.
In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.
Perioperative mechanical ventilation plays a role in lung injury and postoperative pulmonary complications, yet a consensus in the literature concerning the key clinical question of how to best provide lung protection during mechanical ventilation in surgical patients is lacking. It is necessary to develop an expert consensus on perioperative mechanical ventilation suitable for Chinese anesthesiologists to better guide clinical practice. The experts from the Anesthesia Committee of Chengdu Medical Association and the Chongqing Medical Association Anesthesiology Branch were organized by West China Hospital of Sichuan University to propose the question regarding the perioperative mechanical ventilation, and the current literature was then reviewed, and expert opinions were solicited to provide evidence-based guidance. Subsequently, the expert panel reached a consensus and formulated 28 recommendations with evidence of moderate to high quality using the modified Delphi method.
Objective To investigate the factors influencing the occurrence of postoperative pulmonary complications (PPCs) in liver transplant recipients and to construct Nomogram model to identify high-risk patients. Methods The clinical data of 189 recipients who underwent liver transplantation at the General Hospital of Eastern Theater Command from November 1, 2019 to November 1, 2022 were retrospective collected, and divided into PPCs group (n=61) and non-PPCs group (n=128) based on the occurrence of PPCs. Univariate and multivariate logistic regression analyses were used to determine the risk factors for PPCs, and the predictive effect of the Nomogram model was evaluated by receiver operator characteristic curve (ROC) and calibration curve. Results Sixty-one of 189 liver transplant patients developed PPCs, with an incidence of 32.28%. Univariate analysis results showed that PPCs were significantly associated with age, smoking, Child-Pugh score, combined chronic obstructive pulmonary disease (COPD), combined diabetes mellitus, prognostic nutritional index (PNI), time to surgery, amount of bleeding during surgery, and whether or not to diuretic intraoperatively (P<0.05). Multivariate logistic regression analysis showed that age [OR=1.092, 95%CI (1.034, 1.153), P=0.002], Child-Pugh score [OR=1.575, 95%CI (1.215, 2.041), P=0.001], combined COPD [OR=4.578, 95%CI (1.832, 11.442), P=0.001], combined diabetes mellitus [OR=2.548, 95%CI (1.024, 6.342), P=0.044], preoperative platelet count (PLT) [OR=1.076, 95%CI (1.017, 1.138), P=0.011], and operative time [OR=1.061, 95%CI (1.012, 1.113), P=0.014] were independent risk factors for PPCs. The prediction model for PPCs which constructed by using the above six independent risk factors in Nomogram had an area under the ROC curve of 0.806. Hosmer and Lemeshow goodness of fit test (P=0.129), calibration curve, and decision curve analysis showed good agreement with Nomogram model. Conclusion The Nomogram model constructed based on age, Child-Pugh score, combined COPD, combined diabetes mellitus, preoperative PLT, and time of surgery can better identify patients at high risk of developing PPCs after liver transplantation.
Objective To investigate the relationship between two-lung ventilation (TLV) with single-lumen endotracheal tube (SLT), one-lung ventilation (OLV) with double-lumen endotracheal tube (DLT) and postoperative pulmonary complications (PPCs) after total thoracoscopic cardiac surgery. Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed. The patients were divided into 2 group according to the type of endotracheal tube, including a SLT group and a DLT group. Baseline data, surgical variables and PPCs were compared. The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis. Results Finally 349 patients were enrolled, including 180 males and 169 females with an average age of (50.0±14.8) years. There were 219 patients in the SLT group and 130 patients in the DLT group. There was no statistical difference in baseline data, surgical variables or PPCs between the two groups (P＞0.05). Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group (OR=0.778, 95%CI 0.637 to 0.951, P=0.014) and preoperative smoking history in the DLT group (OR=0.058, 95%CI 0.004 to 0.903, P=0.042). Conclusion For the patients who undergo totally thoracoscopic cardiac surgery, TLV with SLT and OLV with DLT show no significant association with PPCs. At the same time, PPCs are associated with body mass index in the SLT group, while associated with preoperative smoking history in the DLT group.