ObjectiveTo determine the predictive value of preoperative systemic immune-inflammatory index (SII) regarding the development of postoperative pulmonary complications (PPCs) after abdominal surgery.MethodsThisretrospective study involved 433 patients undergoing elective abdominal surgery. Logistic regression risk model was used to evaluate the prognostic value of SII. We drew the receiver-operating characteristic (ROC) curve and calculated the area under the ROC curve to compared the predictive ability of SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to- lymphocyte ratio (MLR).ResultsThe independent risk factors of PPCs were preoperative respiratory diseases, preoperative history of chronic liver disease, maintenance of intravenous or inhalation anesthesia, and intraoperative infusion of more colloid (P<0.05). However, SII, PLR, NLR, and MLR did not predict the occurrence of PPCs, and they also did not predict ≥3 grade of PPCs (AUC<0.60, P>0.05).ConclusionsPreoperative SII is not a prognostic biomarker of PPCs occurrence in patients undergoing elective abdominal surgery. Other biomarkers, such as PLR, NLR, and MLR, also have no predictive value for the PPCs in these patients.
ObjectiveTo investigate the clinical characteristics and risk factors of postoperative pulmonary complications (PPCs) in patients undergoing major abdominal surgery. MethodsA 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. ResultsA 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). ConclusionsThe 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.