ABSTRACT
OBJECTIVES: To assess the utility of preoperative chest radiographic findings for predicting cardiopulmonary complications in smokers undergoing transurethral resection of urinary bladder tumors under spinal anesthesia. To analyze perioperative changes in attitude in this setting. MATERIAL AND METHODS: Prospective study of 309 smokers with > or = 20 pack-years of cumulative smoking who were candidates for transurethral resection of urinary bladder tumors. The patients were classified in 2 groups according to radiographic findings. Between groups we compared the incidence of cardiopulmonary complications, perioperative changes in attitude to anesthesia and surgery, delays in completing the preanesthesia workup, and differences in the duration of surgery and hospital stay. RESULTS: Patients older than 65 years were 1.92 times more likely to have significant findings on the chest radiograph. Radiographic findings were associated with a higher incidence of perioperative complications (P=.02), need for further preoperative consultations (P<.01), longer delay in completing the preanesthesia study (P<.01), longer mean (SD) hospital stay (3.43 [3.17] days vs 2.50 [1.77] days, P<.001), and longer duration of surgery (P<.001). Attitudes did not change in relation to radiographic findings during or after surgery. Chest radiography correctly classified 3.54% of the patients with complications (predictive value). CONCLUSIONS: The predictive value of chest radiography for cardiopulmonary complications is low and findings do not influence intra- or postoperative attitudes. We therefore find no justification for performing chest x-rays in the population studied.
Subject(s)
Cardiovascular Diseases/diagnostic imaging , Cystectomy/methods , Lung Diseases/diagnostic imaging , Preoperative Care , Radiography, Thoracic , Smoking , Urinary Bladder Neoplasms/surgery , Age Factors , Aged , Anesthesia/adverse effects , Anesthesia/methods , Anesthesia, Spinal , Cardiovascular Diseases/complications , Female , Humans , Intraoperative Complications/prevention & control , Lung Diseases/complications , Male , Middle Aged , Patient Care Planning , Smoking/adverse effects , Subarachnoid Space , Urinary Bladder Neoplasms/complicationsABSTRACT
Objetivo: Evaluar la utilidad de la radiografía de tórax preoperatoria como predictor de complicaciones cardiorrespiratorias y de cambios de actitud perioperatoria en pacientes con historia de tabaquismo intervenidos mediante resección transuretral de cáncer vesical con anestesia subaracnoidea. Material y métodos: Estudio prospectivo de 309 pacientes con consumo acumulado de tabaco de al menos 20 paquetes-año candidatos a resección transuretral de tumor vesical, clasificados en dos grupos en función de la presencia de hallazgos significativos en la radiografía. Se estudió la incidencia de complicaciones cardiorrespiratorias, cambios de actitud anestésico-quirúrgica perioperatoria y demoras en la finalización del estudio preanestésico en ambos grupos, así como las diferencias en la duración de intervención y el tiempo de estancia hospitalaria. Resultados: Los pacientes mayores de 65 años mostraron 1,92 veces más probabilidad de presentar hallazgos radiológicos significativos. Éstos se asociaron a mayor incidencia de complicaciones perioperatorias (p = 0,02), más solicitud de interconsultas preoperatorias (p < 0,01), y más demoras en la finalización del estudio preanestésico (p < 0,01); así como a mayor estancia hospitalaria (3,43 ± 3,17 frente a 2,50 ± 1,77 días; p < 0,001) y más duración de la cirugía (p < 0,001). No se produjo ningún cambio de actitud intra ni postoperatoria debido a hallazgos radiológicos. El valor predictivo de la radiografía preoperatoria para complicaciones perioperatorias fue de 3,54%. Conclusiones: La radiografía de tórax carece de un adecuado valor predictivo para complicaciones cardiorrespiratorias y no influye sobre la actitud intra o postoperatoria, por lo que no encontramos justificado su empleo en la población estudiada(AU)
Objectives: To assess the utility of preoperative chest radiographic findings for predicting cardiopulmonary complications in smokers undergoing transurethral resection of urinary bladder tumors under spinal anesthesia. To analyze perioperative changes in attitude in this setting. Material and methods: Prospective study of 309 smokers with >= 20 pack-years of cumulative smoking who were candidates for transurethral resection of urinary bladder tumors. The patients were classified in 2 groups according to radiographic findings. Between groups we compared the incidence of cardiopulmonary complications, perioperative changes in attitude to anesthesia and surgery, delays in completing the preanesthesia workup, and differences in the duration of surgery and hospital stay. Results: Patients older than 65 years were 1.92 times more likely to have significant findings on the chest radiograph. Radiographic findings were associated with a higher incidence of perioperative complications (P=.02), need for further preoperative consultations (P<.01), longer delay in completing the preanesthesia study (P<.01), longer mean (SD) hospital stay (3.43 [3.17] days vs 2.50 [1.77] days, P<.001), and longer duration of surgery (P<.001). Attitudes did not change in relation to radiographic findings during or after surgery. Chest radiography correctly classified 3.54% of the patients with complications (predictive value). Conclusions: The predictive value of chest radiography for cardiopulmonary complications is low and findings do not influence intra- or postoperative attitudes. We therefore find no justification for performing chest x-rays in the population studied(AU)
