ABSTRACT
Post-operative pulmonary complications after non-cardiothoracic surgery are common and can adversely affect morbidity, mortality and length of hospital stay. Knowledge as regards factors predicting postoperative pulmonary complications in our local setting is imperfect. To study factors predicting post-operative pulmonary complications in developing countries. Data of consecutive 404 patients undergoing non-cardiothoracic surgery under general anesthesia with tracheal intubation was collected prospectively from Jan 2009 to Dec 2010. Chi-square was used for univariate analysis. Multivariate analysis was conducted using forward stepwise logistic regression. The mean age was 36 +/- 18 years with slight male predominence [54% vs 46%]. 22% [n=89] were smokers and the mean Body Mass Index was 23 +/- 4.5 kg/m2 with 35% [n=141] overweight and obese. 5% [n=20] of subjects had pre-existing chronic lung conditions while 23% [n=92] had non-pulmonary chronic conditions. 70% [n=282] of the surgeries were done electively and the mean duration of anesthesia was 78 +/- 44 minutes. The overall postoperative pulmonary complications rate was 8% [n=31] with atelactasis [48%, n=16] followed by bronchospasm [25%, n=8] and pneumonia [16%, n=5] being the commonest complications. The duration of hospital stay was significantly longer [11 +/- 9 days, p=0.00] in patients with post-operative pulmonary complications and 29% [n=9] of them required mechanical ventilation. Logistic Regression analysis identified premorbid chronic chest conditions, emergency surgery and prolonged duration of anesthesia as significant predictors of post-operative pulmonary complications while age, gender, Body Mass Index, smoking history and non-pulmonary premorbids were insignificant in this regard. Post-operative pulmonary complications after non-cardiothoracic surgery are common and lead to increased morbidity and prolonged hospital stay in our setting. We identified pre-existing chest disease, prolonged anesthesia and emergency surgery as significant predictors of post-operative pulmonary complications
ABSTRACT
Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities