Predictors of postoperative pulmonary complications following elective general surgery: a prospective observational cohort study.

Abstract

Background Postoperative pulmonary complications (PPCs) contribute substantially to morbidity, prolonged hospitalisation, and critical-care use after major surgery. Identifying readily available clinical predictors can improve perioperative risk stratification. Objectives To determine the cumulative incidence and pattern of PPCs and identify clinical and perioperative predictors following elective general surgery Methods This single-centre prospective observational cohort study included 100 adults undergoing elective general surgery at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, India, from January to December 2025. Demographic, clinical, anaesthetic, and operative variables were recorded prospectively. Patients were followed throughout postoperative hospitalisation for new PPCs. Associated factors were examined using univariate analysis and multivariable logistic regression. Results Twenty-four patients developed at least one new PPC, yielding a cumulative incidence of 24.0% (24 cases per 100 patients). Univariate associations were observed for age ≥60 years (P=0.004), smoking (P=0.014), pre-existing respiratory disease (P=0.004), ASA III status (P=0.012), open surgery (P=0.010), upper abdominal surgery (P=0.006), operative duration >150 minutes (P=0.020), and postoperative nasogastric tube use (P=0.026). Independent predictors were age ≥60 years (aOR 2.84, 95% CI 1.05-7.68; P=0.039), smoking (aOR 2.67, 95% CI 1.01-7.08; P=0.048), respiratory disease (aOR 3.72, 95% CI 1.18-11.76; P=0.025), upper abdominal surgery (aOR 3.18, 95% CI 1.12-9.02; P=0.030), and operative duration >150 minutes (aOR 2.74, 95% CI 1.01-7.45; P=0.048). PPCs were associated with longer hospital stay (8.6±3.4 vs 5.1±2.0 days; P<0.001) and more ICU admissions (29.2% vs 5.3%; P=0.003). Conclusion PPCs affected approximately one-quarter of patients after elective general surgery. A small set of routinely identifiable clinical and operative characteristics independently predicted postoperative pulmonary morbidity. Recommendations Structured pulmonary risk assessment, smoking cessation, optimisation of respiratory disease, lung-protective perioperative care, early mobilisation, and enhanced surveillance should be prioritised in high-risk patients.