Clinical characteristics and risk factors of postoperative pulmonary complications following abdominal surgery: a secondary analysis study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xin ¹ , LI Xuefei ¹ , ZHANG Yutong ¹ , WANG Zaili ² , XU Yi ³ ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of Center for Orthopedics & Pain Management, The Fifth People’s Hospital of Sichuan Province, Chengdu 610031, P. R. China;
3. Department of Anesthesiology, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding?author：

YU Hai, Email: yuhai@scu.edc.cn

Keywords：

pulmonary complication; abdominal surgery; influencing factor

DOI：

10.7507/1007-9424.202511017

Video：

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Objective To investigate the clinical characteristics and risk factors of postoperative pulmonary complications (PPCs) in patients undergoing major abdominal surgery. Methods A secondary analysis was performed using data from three prospective randomized controlled trials conducted at West China Hospital of Sichuan University between 2018 and 2023. Demographic characteristics, perioperative variables, and the occurrence of PPCs within 7 and 30 days after surgery were collected. Multivariable logistic regression analysis was used to identify factors associated with PPCs. Results A total of 2 047 patients undergoing elective major abdominal surgery were included. ① PPCs within 7 days: PPCs occurred in 686 patients (33.5%) within 7 days after surgery. The most common types were atelectasis (453, 66.0%) and pulmonary infection (322, 46.9%). Grade 3 PPCs accounted for the largest proportion (353, 51.5%), and the occurrence of a single PPC was most frequent (392, 57.1%). Increased BMI (OR=1.059, P<0.001), current smoking or smoking cessation for less than 1 month (OR=1.426, P=0.007), history of respiratory disease (OR=1.607, P=0.002), upper abdominal surgery (lower abdominalsurgery vs. upper abdominal surgery: OR=0.633, P=0.036), open surgery (OR=1.841, P<0.001), prolonged operativeduration (OR=1.003, P<0.001), and increased total fluid volume (OR=1.051, P<0.001) were identified as risk factors for PPCs within 7 days. ② PPCs within 30 days: PPCs occurred in 340 patients (16.6%) within 30 days after surgery. Atelectasis (213, 62.6%) and pulmonary infection (157, 46.2%) remained the most common complications, and the occurrence of a single PPC was still predominant (166, 48.8%). Multivariable logistic regression analysis demonstrated that female (OR=1.592, P=0.024), smoking cessation for more than 1 month (OR=1.738, P=0.030), history of respiratory disease (OR=1.788, P=0.011), open surgery (OR=11.986, P<0.001), prolonged operative duration (OR=1.002, P=0.016), and increased total fluid volume (OR=1.122, P<0.001) were independent risk factors for PPCs within 30 days after surgery. Patients who developed PPCs within 7 days postoperatively had a markedly increased risk of developing PPCs within 30 days (OR=50.932, P<0.001). Conclusions The incidence of PPCs within 7 and 30 days after major abdominal surgery is high, with atelectasis and pulmonary infection being the most common types. Increased BMI, smoking history, history of respiratory disease, upper abdominal surgery, open surgery, prolonged operative duration, and increased total fluid volume are significant risk factors for PPCs within 7 days. PPCs within 7 days are strongly associated with the occurrence of PPCs within 30 days.

Citation： WANG Xin, LI Xuefei, ZHANG Yutong, WANG Zaili, XU Yi, YU Hai. Clinical characteristics and risk factors of postoperative pulmonary complications following abdominal surgery: a secondary analysis study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(6): 790-798. doi: 10.7507/1007-9424.202511017 Copy

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2.	Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
3.	Gebeyehu G, Eshetu A, Aweke S. Incidence and associated factors of postoperative pulmonary complications after abdominal surgery in the Public Hospital, Addis Ababa, Ethiopia. Anesthesiol Res Pract, 2022, 2022: 8223903. doi: 10.1155/2022/8223903.
4.	Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the Perioperative Research Network Investigators. JAMA Surg, 2017, 152(2): 157-166.
5.	Li XF, Jiang D, Jiang YL, et al. Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: a randomized controlled trial. J Clin Anesth, 2020, 67: 110009. doi: 10.1016/j.jclinane.2020.110009.
6.	Li X, Xu Y, Wang Z, et al. Effect of ventilation mode on postoperative pulmonary complications among intermediate- to high-risk patients undergoing abdominal surgery: a randomized controlled trial. Anaesth Crit Care Pain Med, 2024, 43(6): 101423. doi: 10.1016/j.accpm.2024.101423.
7.	Zhang YT, Han Y, Zhuang HJ, et al. Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: a randomized controlled trial. J Clin Anesth, 2024, 99: 111676. doi: 10.1016/j.jclinane.2024.111676.
8.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
9.	Ferrando-Ortolá C; iPROVE Research Network Group for the PEALS study. Postoperative pulmonary complications in emergency abdominal surgery. A prospective international cohort study. Anaesth Crit Care Pain Med, 2025, 44(5): 101560. doi: 10.1016/j.accpm.2025.101560.
10.	Kokotovic D, Berkfors A, G?genur I, et al. The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdominal surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg, 2021, 47(4): 975-990.
11.	Mo J, Wang D, Xiao J, et al. Effects of lung protection ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials. BMC Anesthesiol, 2024, 24(1): 346. doi: 10.1186/s12871-024-02737-w.
12.	Shiramoto K, Wakamatsu H, Kametani Y, et al. Effect of high body mass index on postoperative pulmonary complications: a retrospective study. Ain-Shams J Anesthesiology, 2023, 15(1): 13.
13.	Plassmeier L, Hankir MK, Seyfried F. Impact of excess body weight on postsurgical complications. Visc Med, 2021, 37(4): 287-297.
14.	Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011, 124(2): 144-154.e8.
15.	Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: a systematic review and meta-analysis. J Clin Anesth, 2025, 106: 111967. doi: 10.1016/j.jclinane.2025.111967.
16.	王再莉, 李雪霏, 玉紅, 等. 全身免疫炎癥指數對腹部手術患者術后肺部并發癥的影響: 回顧性觀察性研究. 中國普外基礎與臨床雜志, 2021, 28(5): 625-630.
17.	Guo Y, Cao F, Ding Y, et al. Laparoscopic major gastrointestinal surgery is safe for properly selected patient with COPD: a meta-analysis. Biomed Res Int, 2019, 2019: 8280358. doi: 10.1155/2019/8280358.
18.	Bohne A, Grundler E, Knüttel H, et al. Impact of laparoscopic versus open surgery on humoral immunity in patients with colorectal cancer: a systematic review and meta-analysis. Surg Endosc, 2024, 38(2): 540-553.
19.	Cheng H, Clymer JW, Po-Han Chen B, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res, 2018, 229: 134-144.
20.	Baar W, Semmelmann A, Anselm F, et al. Risk factors for postoperative pulmonary complications in patients undergoing thoracotomy for indications other than primary lung cancer resection: a multicenter retrospective cohort study from the German Thorax Registry. J Clin Med, 2025, 14(5): 1565. doi: 10.3390/jcm14051565.
21.	孫琪榮, 李卓檸, 余海. 腹部大手術圍手術期液體管理的研究進展. 國際麻醉學與復蘇雜志, 2022, 43(8): 882-886.
22.	Ostermann M, Auzinger G, Grocott M, et al. Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative. Br J Anaesth, 2024, 133(6): 1263-1275.
23.	Vermeulen TD, Hol L, Swart P, et al. Sex dependence of postoperative pulmonary complications - a post hoc unmatched and matched analysis of LAS VEGAS. J Clin Anesth, 2024, 99: 111565. doi: 10.1016/j.jclinane.2024.111565.
24.	He Q, Lai Z, Peng S, et al. Postoperative pulmonary complications after major abdominal surgery in elderly patients and its association with patient-controlled analgesia. BMC Geriatr, 2024, 24(1): 751. doi: 10.1186/s12877-024-05337-y.

1. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
2. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
3. Gebeyehu G, Eshetu A, Aweke S. Incidence and associated factors of postoperative pulmonary complications after abdominal surgery in the Public Hospital, Addis Ababa, Ethiopia. Anesthesiol Res Pract, 2022, 2022: 8223903. doi: 10.1155/2022/8223903.
4. Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the Perioperative Research Network Investigators. JAMA Surg, 2017, 152(2): 157-166.
5. Li XF, Jiang D, Jiang YL, et al. Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: a randomized controlled trial. J Clin Anesth, 2020, 67: 110009. doi: 10.1016/j.jclinane.2020.110009.
6. Li X, Xu Y, Wang Z, et al. Effect of ventilation mode on postoperative pulmonary complications among intermediate- to high-risk patients undergoing abdominal surgery: a randomized controlled trial. Anaesth Crit Care Pain Med, 2024, 43(6): 101423. doi: 10.1016/j.accpm.2024.101423.
7. Zhang YT, Han Y, Zhuang HJ, et al. Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: a randomized controlled trial. J Clin Anesth, 2024, 99: 111676. doi: 10.1016/j.jclinane.2024.111676.
8. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
9. Ferrando-Ortolá C; iPROVE Research Network Group for the PEALS study. Postoperative pulmonary complications in emergency abdominal surgery. A prospective international cohort study. Anaesth Crit Care Pain Med, 2025, 44(5): 101560. doi: 10.1016/j.accpm.2025.101560.
10. Kokotovic D, Berkfors A, G?genur I, et al. The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdominal surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg, 2021, 47(4): 975-990.
11. Mo J, Wang D, Xiao J, et al. Effects of lung protection ventilation strategies on postoperative pulmonary complications after noncardiac surgery: a network meta-analysis of randomized controlled trials. BMC Anesthesiol, 2024, 24(1): 346. doi: 10.1186/s12871-024-02737-w.
12. Shiramoto K, Wakamatsu H, Kametani Y, et al. Effect of high body mass index on postoperative pulmonary complications: a retrospective study. Ain-Shams J Anesthesiology, 2023, 15(1): 13.
13. Plassmeier L, Hankir MK, Seyfried F. Impact of excess body weight on postsurgical complications. Visc Med, 2021, 37(4): 287-297.
14. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011, 124(2): 144-154.e8.
15. Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: a systematic review and meta-analysis. J Clin Anesth, 2025, 106: 111967. doi: 10.1016/j.jclinane.2025.111967.
16. 王再莉, 李雪霏, 玉紅, 等. 全身免疫炎癥指數對腹部手術患者術后肺部并發癥的影響: 回顧性觀察性研究. 中國普外基礎與臨床雜志, 2021, 28(5): 625-630.
17. Guo Y, Cao F, Ding Y, et al. Laparoscopic major gastrointestinal surgery is safe for properly selected patient with COPD: a meta-analysis. Biomed Res Int, 2019, 2019: 8280358. doi: 10.1155/2019/8280358.
18. Bohne A, Grundler E, Knüttel H, et al. Impact of laparoscopic versus open surgery on humoral immunity in patients with colorectal cancer: a systematic review and meta-analysis. Surg Endosc, 2024, 38(2): 540-553.
19. Cheng H, Clymer JW, Po-Han Chen B, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res, 2018, 229: 134-144.
20. Baar W, Semmelmann A, Anselm F, et al. Risk factors for postoperative pulmonary complications in patients undergoing thoracotomy for indications other than primary lung cancer resection: a multicenter retrospective cohort study from the German Thorax Registry. J Clin Med, 2025, 14(5): 1565. doi: 10.3390/jcm14051565.
21. 孫琪榮, 李卓檸, 余海. 腹部大手術圍手術期液體管理的研究進展. 國際麻醉學與復蘇雜志, 2022, 43(8): 882-886.
22. Ostermann M, Auzinger G, Grocott M, et al. Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative. Br J Anaesth, 2024, 133(6): 1263-1275.
23. Vermeulen TD, Hol L, Swart P, et al. Sex dependence of postoperative pulmonary complications - a post hoc unmatched and matched analysis of LAS VEGAS. J Clin Anesth, 2024, 99: 111565. doi: 10.1016/j.jclinane.2024.111565.
24. He Q, Lai Z, Peng S, et al. Postoperative pulmonary complications after major abdominal surgery in elderly patients and its association with patient-controlled analgesia. BMC Geriatr, 2024, 24(1): 751. doi: 10.1186/s12877-024-05337-y.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical characteristics and risk factors of postoperative pulmonary complications following abdominal surgery: a secondary analysis study

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