The Role of Pre-Operative Spirometry and Chest Radiography in Predicting Post-Operative Pulmonary Complications After Abdominal Surgery

Abstract

Background: Post-operative pulmonary complications (POPCs) are a major cause of morbidity and prolonged hospital stay following abdominal surgery. In low-resource settings, the predictive utility of routine pre-operative tests like spirometry and chest radiography remains underexplored. This study evaluated the role of these investigations in predicting POPCs in a Nigerian tertiary hospital.

Methods: A prospective observational study was conducted with 100 patients scheduled for elective abdominal surgery. Participants underwent pre-operative spirometry and chest radiography. They were followed for seven days post-operatively for the occurrence of POPCs, defined by standard clinical and radiological criteria.

Results: Over half of the patients (56, 56.0%) had abnormal spirometry, primarily a restrictive pattern (46, 46.0%). Pre-operative chest radiographs were abnormal in 34 (34.0%) of patients. Radiographic findings of fibrosis and hyperinflation were significantly associated with the development of POPCs. Among patients with fibrosis, 6 (75.0%) developed POPCs compared to 33 (35.8%) without (p=0.033). Similarly, 5 (83.3%) patients with hyperinflation developed POPCs versus 34 (36.1%) without (p=0.028). Patients with fibrosis most frequently developed hypoxemia with infiltrates and pneumonia, while those with hyperinflation commonly had non-productive cough and pneumonia.

Conclusion: Pre-operative spirometry and chest radiography are valuable tools for identifying patients at high risk for POPCs. A restrictive pattern on spirometry, along with radiographic evidence of fibrosis or hyperinflation, are significant predictors. Their routine use in pre-operative assessment can facilitate early risk stratification and guide preventive care, potentially improving surgical outcomes in resource-limited settings.