Risk Factors Analysis Of Pulmonary Complications After Hepatectomy

Objective: Exploring the risk factors for postoperative pulmonary complications(PPCs)in hepatobiliary surgery can assist clinicians in implementing effective individualized prevention and treatment strategies during the perioperative period.This approach can help reduce the incidence of PPCs by targeting high-risk factors in patients,and provide valuable references for subsequent clinical work.Methods: We retrospectively analyzed the medical records of 412 patients who underwent hepatectomy in the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Kunming Medical University between June 2020 and June 2022.Based on proposed inclusion and exclusion criteria,5 patients with incomplete data were excluded,leaving 407 patients for analysis.Patients were categorized into either a complication group(n=225)or non-complication group(n=182)based on the presence or absence of perioperative pulmonary complications(PPCs).The medical records of all patients were reviewed for demographic information,medical history,and various preoperative,intraoperative,and postoperative data including laboratory values,surgical details,and hospitalization outcomes.Preoperative data included chest X-ray abnormalities,smoking history,history of respiratory diseases,history of abdominal surgery,history of coronary heart disease,history of cerebrovascular accident,history of liver disease,history of hypertension,history of diabetes,preoperative airway assessment,ASA anesthesia score,portal hypertension,portal vein tumor thrombus,preoperative white blood cells,red blood cells,platelets,hemoglobin,albumin,and prothrombin activity.Intraoperative data included surgical method,hepatectomy range,incision type,operation time,intraoperative infusion volume,blood transfusion volume,bleeding volume,and urine volume.Postoperative data included ICU time,intubation time,nasogastric tube indwelling time,abdominal drainage tube indwelling time,analgesia pump time,white blood cells,albumin,hospital stay,total hospital stay,and total hospitalization expenses.Univariate analysis was performed to identify potential risk factors for PPCs,and variables with significant differences between the two groups were included in multivariate logistic regression analysis to determine independent predictors.Using the results of the multivariate analysis,a predictive model for PPCs after hepatectomy was established and evaluated for accuracy using the Hosmer-Lemeshow test.The receiver operating characteristic(ROC)curve was used to evaluate the predictive accuracy of the model for the occurrence of PPCs following hepatectomy.Results: The study included 407 patients(187 males and 220 females)who met the inclusion and exclusion criteria.Of these patients,225(55.3%)developed PPCs following hepatectomy.Univariate and multivariate logistic regression analyses identified smoking history,previous history of abdominal surgery,intraoperative fluid intake,tracheal intubation time,and indwelling time of abdominal drainage tube as independent risk factors for PPCs after hepatectomy.On the other hand,BMI,preoperative albumin,and postoperative albumin were identified as protective factors.The multivariate logistic regression analysis yielded a regression equation for the prediction of outcomes.The goodness of fit of the model was assessed using the Hosmer-Lemeshow test equation,with a P-value of 0.169,indicating a good fit.The prediction model was used to calculate predicted values,and an ROC curve was constructed.The area under the curve was 0.858 with a significance level of P<0.001,suggesting that the model had a good predictive performance.Conclusion: The findings of this study revealed that the incidence of PPCs in hepatectomy was 55.3 %.Smoking history,previous abdominal surgery,intraoperative intake of fluids(≥ 3500ml),prolonged tracheal intubation time,and extended duration of abdominal drainage tube indwelling were identified as independent risk factors for PPCs.In contrast,BMI,high preoperative albumin,and high postoperative albumin were identified as protective factors against PPCs.Therefore,personalized preventive interventions should be developed based on patients’ risk factors to mitigate the occurrence of PPCs following hepatectomy.