Modifiable And Non-Modifiable Risk Factors For Pulmonary Morbidity Following Elective Abdominal Surgery
Keywords:
Abdominal surgery, Morbidity, Post-operative Pulmonary complications, Risk factorsAbstract
Postoperative pulmonary complications are a major cause of morbidity and mortality following abdominal surgery, prolonging hospital stay and recovery. They result from a combination of modifiable and non-modifiable factors such as age, comorbidities, smoking, nutrition, and perioperative management. Data on these risk factors remain limited in Nigerian surgical populations. This study assessed the determinants of pulmonary morbidity following elective abdominal surgery at the University of Benin Teaching Hospital. A prospective cross-sectional study was conducted between January and June 2025 among 100 adult patients who underwent elective abdominal surgery. Data on socio- demographic variables, comorbidities, intraoperative characteristics and postoperative outcomes were collected using a structured questionnaire. Pulmonary morbidity, including pneumonia, atelectasis, bronchospasm, pulmonary embolism or respiratory failure was defined using the European Perioperative Clinical Outcome criteria. Statistical analysis was performed with SPSS version 26.0 using chi-square and logistic regression, with significance set at p < 0.05. The mean age of participants was 49.2 ± 12.9 years, comprising 59 (59.0%) females and 41 (41.0%) males. Pulmonary complications were more frequent in patients older than 60 years (69.6%) and in those with pre-operative shortness of breath (88.9%). Significant predictors included smoking (p = 0.014), low serum albumin (p = 0.021), COPD (p = 0.025), use of long-acting muscle relaxants (p = 0.048), prolonged surgery > 2 hours (p < 0.001) and elevated pre-operative respiratory rate (p = 0.010). ASA Class III patients had the highest complication rate (73.1%). Postoperative pulmonary complications arise from both modifiable and non-modifiable factors. Modifiable risks such as smoking, obesity, poor pulmonary conditioning, and delayed mobilization can be mitigated through preoperative optimization and adherence to perioperative care bundles, whereas non-modifiable factors like advanced age and chronic lung disease require careful risk stratification. Focusing on modifiable factors offers the greatest potential to reduce the burden of POPCs and improve surgical outcomes, especially in resource-limited settings.
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