Postoperative pulmonary complications (PPCs) are important contributors to mortality
and morbidity after surgery. The available predicting models are useful in preoperative
risk assessment, but there is a need for validated tools for the early postoperative
period as well. Lung ultrasound is becoming popular in intensive and perioperative
care and there is a growing interest to evaluate its role in the detection of postoperative
pulmonary pathologies.We aimed to identify characteristics with the potential of recognizing
patients at risk by comparing the lung ultrasound scores (LUS) of patients with/without
PPC in a 24-h postoperative timeframe.Observational study at a university clinic.
We recruited ASA 2-3 patients undergoing elective major abdominal surgery under general
anaesthesia. LUS was assessed preoperatively, and also 1 and 24 h after surgery. Baseline
and operative characteristics were also collected. A one-week follow up identified
PPC+ and PPC- patients. Significantly differing LUS values underwent ROC analysis.
A multi-variate logistic regression analysis with forward stepwise model building
was performed to find independent predictors of PPCs.Out of the 77 recruited patients,
67 were included in the study. We evaluated 18 patients in the PPC+ and 49 in the
PPC- group. Mean ages were 68.4 ± 10.2 and 66.4 ± 9.6 years, respectively (p = 0.4829).
Patients conforming to ASA 3 class were significantly more represented in the PPC+
group (66.7 and 26.5%; p = 0.0026). LUS at baseline and in the postoperative hour
were similar in both populations. The median LUS at 0 h was 1.5 (IQR 1-2) and 1 (IQR
0-2; p = 0.4625) in the PPC+ and PPC- groups, respectively. In the first postoperative
hour, both groups had a marked increase, resulting in scores of 6.5 (IQR 3-9) and
5 (IQR 3-7; p = 0.1925). However, in the 24th hour, median LUS were significantly
higher in the PPC+ group (6; IQR 6-10 vs 3; IQR 2-4; p < 0.0001) and it was an independent
risk factor (OR = 2.6448 CI95% 1.5555-4.4971; p = 0.0003). ROC analysis identified
the optimal cut-off at 5 points with high sensitivity (0.9444) and good specificity
(0.7755).Postoperative LUS at 24 h can identify patients at risk of or in an early
phase of PPCs.
