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. 2024 Mar 29;13(7):1996.
doi: 10.3390/jcm13071996.

Pulmonary Hypertension and the Risk of 30-Day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score-Weighted Cohort Analysis

Yoshio Tatsuoka  1   2 , Zyad J Carr  1   2 , Sachidhanand Jayakumar  3 , Hung-Mo Lin  1   2   4 , Zili He  4 , Adham Farroukh  5 , Paul Heerdt  1   2
Affiliations

Pulmonary Hypertension and the Risk of 30-Day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score-Weighted Cohort Analysis

Yoshio Tatsuoka et al. J Clin Med. .

Abstract

Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPCs). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study was conducted on 164 patients with a mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia and a control cohort (N = 1981). The primary outcome was PPCs, and the secondary outcomes were PPC sub-composites, namely respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. Results: PPCs were higher in the PH cohort (29.9% vs. 11.2%, p < 0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, p < 0.001) and PNA (11.2% vs. 5.7%, p = 0.01) were observed. After OW, PH was still associated with greater PPCs (RR 1.66, 95% CI (1.05-2.71), p = 0.036) and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPCs between pre- and post-capillary PH patients. Conclusions: After covariate balancing, PH was associated with a higher risk for PPCs and prolonged LOS. This elevated PPC risk should be considered during preoperative risk assessment.

Keywords: Agency for Healthcare Research and Quality; perioperative outcomes; postoperative mortality; postoperative pulmonary complications; propensity score overlap weighting; pulmonary hypertension.

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Conflict of interest statement

We have not received any external funding specifically for this research, but the following authors have external fundings for their other research projects. Z.C. reported receiving study grants from Shape Medical Systems, Inc. P.H. reported receiving research support grants from Edwards Lifesciences and consulting and royalty fees from Baudax Bio, Fire1Foundry, Cardiage LLC and Edwards Lifesciences.

Figures

Figure 1
Figure 1
A flow diagram of patient selection criteria. Abbreviations: PH: pulmonary hypertension; ASA: American Society of Anesthesiologists Physical Status; RHC: right heart catheterization; mPAP: mean pulmonary artery pressure.
Figure 2
Figure 2
A comparison of PH vs. control cohorts’ unadjusted incidence of PPC and sub-composites.
See this image and copyright information in PMC

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