Don't forget the heart when looking at the risk of postoperative pulmonary complications.

摘要

We read with great interest the recent study by Canet et al. In this investigation, based on 2,464 surgical patients, the incidence of postoperative pulmonary complications (PPCs) was 5%, with a related mortality rate at Day 30 of 19.5% (95% CI, 12.5-26.5%). Predicting risk factors for PPCs is a cornerstone of better patient management. However, reliable knowledge of PPC incidence in a broad, heterogeneous surgical population remains difficult because of nonrepresentative samples and statistical flaws. Furthermore, definitions of PPC are often not explicit and differ among studies. The recent study of Canet et al. has similarities with that of McAlister et al. Both investigations were built with a strong statistical methodology and included a large representative surgical population. Yet, the 5% incidence of PPC reported by Canet etal. is almost double the 2.7% reported by McAlister et al. This higher rate of complications observed by Canet et al. could be explained, in part, by the inclusion of emergency cases (14.2%), whereas McAlister et al. included only scheduled cases. The risk of PPC increases significantly in emergency cases.3 In addition, Canet et al. included some thoracic surgical cases. Another major difference is related to the use of different PPC definitions. The diagnostic criteria used by McAlister etal. were stricter, including supplementary therapeutic action, such as mechanical ventilation for respiratory failure, percutaneous intervention for treatment of pleural effusion, and bronchoscopic intervention for atelectasis.