Abstract
BACKGROUND
Severe postoperative acute respiratory failure (PARF) is potentially life-threatening. However, risk factors for severe PARF and mortality associated with severe PARF requiring corticosteroids remain unclear. The objectives of this study was to elucidate the occurrence and risk factors of severe PARF and in-hospital mortality after severe PARF.
METHODS
We utilised the Diagnosis Procedure Combination database, a national inpatient database in Japan, to retrospectively extract data on adult patients who underwent thoracic or abdominal surgery under general anaesthesia from April 2012 to March 2013. We performed a multivariable logistic regression analysis for the occurrence of severe PARF, defined by patients who required corticosteroid pulse therapy after surgery.
RESULTS
Among 607,079 patients who met the inclusion criteria, 553,106 underwent abdominal surgery and 53,973 underwent thoracic surgery. A significantly lower proportion of patients underwent corticosteroid pulse therapy in the abdominal than thoracic surgery group (0.2% vs. 1.0%, respectively; p < 0.001). The occurrence of severe PARF requiring corticosteroid pulse therapy was significantly associated with male sex, poor activities of daily living at admission, a longer duration of anaesthesia, thoracic surgery, and preoperative interstitial pneumonia. The mortality in patients who required corticosteroid pulse therapy were 34.2% and 36.7% in the abdominal and thoracic surgery groups, respectively (p = 0.292).
CONCLUSIONS
This large-scale study demonstrated significant risks of the occurrence of severe PARF requiring corticosteroid pulse therapy. Poor clinical outcomes were observed in association with severe PARF.
