• Federico Piccioni, Lorenzo Spagnesi, Paolo Pelosi, Elena Bignami, Marcello Guarnieri, Luca Fumagalli, Enrico Polati, Vittorio Schweiger, Daniela Comi, Rocco D'Andrea, Pierangelo DI Marco, Savino Spadaro, Serena Antonelli, Liliana Sollazzi, Lucia Mirabella, Marina Schiavoni, Cristiana Laici, Jlenia A Marelli, Fabio Fabiani, Lorenzo Ball, Agostino Roasio, Giuseppe Servillo, Matteo Franchi, Patrizia Murino, Marco Irone, Vieri Parrini, Germano DE Cosmo, Giuseppe Cornara, Franco Ruberto, Gilda Pasta, Lorenzo Ferrari, Massimiliano Greco, Maurizio Cecconi, Della RoccaGiorgioGDepartment of Medical Area, University of Udine, Udine, Italy., and PPCs Investigators Group.
• Anesthesia Unit1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy - dr.federico.piccioni@gmail.com.
• Minerva Anestesiol. 2023 Nov 1; 89 (11): 964976964-976.

BackgroundPostoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease.MethodsWe conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality.ResultsPPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001).ConclusionsThe incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery.

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