Predictors of postoperative pulmonary complications following elective general surgery: a prospective observational cohort study.

Golakoti Aditya Raghav; Nisa Shami Un; Bhavani Pidugu

doi:10.51168/w4r4sy98

Authors

Dr. Aditya Raghav Golakoti Associate Professor, Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Dr. Shami Un Nisa Assistant Professor, Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Dr. Pidugu Bhavani Assistant Professor, Department of Anaesthesiaology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/w4r4sy98

Keywords:

postoperative pulmonary complications, general surgery, risk factors, respiratory complications, smoking

Abstract

Background

Postoperative pulmonary complications (PPCs) contribute substantially to morbidity, prolonged hospitalisation, and critical-care use after major surgery. Identifying readily available clinical predictors can improve perioperative risk stratification.

Objectives

To determine the cumulative incidence and pattern of PPCs and identify clinical and perioperative predictors following elective general surgery

Methods

This single-centre prospective observational cohort study included 100 adults undergoing elective general surgery at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, India, from January to December 2025. Demographic, clinical, anaesthetic, and operative variables were recorded prospectively. Patients were followed throughout postoperative hospitalisation for new PPCs. Associated factors were examined using univariate analysis and multivariable logistic regression.

Results

Twenty-four patients developed at least one new PPC, yielding a cumulative incidence of 24.0% (24 cases per 100 patients). Univariate associations were observed for age ≥60 years (P=0.004), smoking (P=0.014), pre-existing respiratory disease (P=0.004), ASA III status (P=0.012), open surgery (P=0.010), upper abdominal surgery (P=0.006), operative duration >150 minutes (P=0.020), and postoperative nasogastric tube use (P=0.026). Independent predictors were age ≥60 years (aOR 2.84, 95% CI 1.05-7.68; P=0.039), smoking (aOR 2.67, 95% CI 1.01-7.08; P=0.048), respiratory disease (aOR 3.72, 95% CI 1.18-11.76; P=0.025), upper abdominal surgery (aOR 3.18, 95% CI 1.12-9.02; P=0.030), and operative duration >150 minutes (aOR 2.74, 95% CI 1.01-7.45; P=0.048). PPCs were associated with longer hospital stay (8.6±3.4 vs 5.1±2.0 days; P<0.001) and more ICU admissions (29.2% vs 5.3%; P=0.003).

Conclusion

PPCs affected approximately one-quarter of patients after elective general surgery. A small set of routinely identifiable clinical and operative characteristics independently predicted postoperative pulmonary morbidity.

Recommendations

Structured pulmonary risk assessment, smoking cessation, optimisation of respiratory disease, lung-protective perioperative care, early mobilisation, and enhanced surveillance should be prioritised in high-risk patients.

Author Biographies

Dr. Aditya Raghav Golakoti, Associate Professor, Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Associate Professor in the Department of General Surgery at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. His academic and clinical interests include general and gastrointestinal surgery, perioperative surgical care, postoperative complications, and clinical outcomes research.
Dr. Shami Un Nisa, Assistant Professor, Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Assistant Professor in the Department of General Surgery at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. Her professional interests include general surgery, perioperative patient management, postoperative outcomes, surgical complications, and clinical research.
Dr. Pidugu Bhavani, Assistant Professor, Department of Anaesthesiaology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is an Assistant Professor in the Department of Anaesthesiology at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. Her areas of professional interest include perioperative medicine, general and regional anaesthesia, postoperative respiratory care, airway management, and anaesthesia-related clinical research.

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