This prospective study intends to investigate the incidence of postoperative pulmonary complications (PPC) or in-hospital mortality in patients with COPD or at risk for COPD undergoing high-risk noncardiac major surgery and to identify relevant risk factors. This study aims to quantify and compare the diagnostic performance of preoperative functional tests, exercise capacity, clinical assessment tests and predictive scoring systems to predict PPC or in-hospital mortality in these patients.
COPD is associated with high perioperative morbidity and mortality and PPC frequently occur in these patients. However, concepts for preoperative pulmonary risk assessment and the predictive value of routine preoperative exercise capacity, clinical assessment and pulmonary function tests are still poorly characterized. Objectives: * To determine the incidence of the composite end point of PPC or all cause in-hospital mortality in patients with confirmed COPD (spirometry) and patients with clinical risk factors in whom spirometry disproved COPD. * To determine the predictive value of exercise capacity, clinical assessment tests, pulmonary function tests and predictive scoring systems to predict the composite end point in these patients. * To identify relevant risk factors and predictors associated with the composite end point. Methodology: Prospective single-centre observational study All patients receive a structured preoperative pulmonary risk assessment with: 1. standardized clinical questionnaire 2. COPD Assessment Test (CAT™) 3. exercise capacity (symptom-limited stair climbing) 4. spirometry 5. capillary blood gas Analysis Postoperative follow-up is planned between the 2nd and 5th day after extubation.
Study Type
OBSERVATIONAL
Enrollment
365
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf
Hamburg, Germany
Composite end point of postoperative pulmonary complications (PPC) or all cause in-hospital mortality
Time frame: until hospital discharge up to 6 months after surgery
Forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) and FEV1 % predicted
Time frame: within 1 week after extubation
Carbon dioxide (pCO2) and oxygen (pO2) partial pressures from blood gas analysis
Time frame: within 1 week after extubation
Postoperative new respiratory symptoms (e.g. dyspnea or wheezing) or treatment for exacerbation (e.g. new systemic glucocorticosteroids or bronchodilators)
Time frame: until hospital discharge up to 6 months after surgery
New pulmonary radiological findings (e.g. pneumonia or pneumothorax)
Time frame: until hospital discharge up to 6 months after surgery
Duration of hospitalization (days)
Time frame: until hospital discharge up to 6 months after surgery
Duration of postoperative respirator support (h)
Time frame: until hospital discharge up to 6 months after surgery
Length of stay in the intensive care unit (days)
Time frame: until hospital discharge up to 6 months after surgery
Frequency of unplanned intensive care unit admission, prolonged oxygen requirement, reintubation, non-invasive ventilation (NIV) or extracorporeal lung assist
Time frame: until hospital discharge up to 6 months after surgery
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