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Standard Postop Care Reduces Pneumonia Risk

Wed, 06/12/2013 - 11:15am
Charles Bankhead

The incidence of postoperative pneumonia and unplanned intubation decreased following implementation of a standardized postoperative care program, investigators reported.

The frequency of postoperative pneumonia declined from 2.6 percent to 1.6 percent and the rate of unplanned intubation from 2.0% to 1.2% in the year after the postoperative care program went into effect, wrote David McAneny, MD, of Boston University Medical Center, and colleagues online in JAMA Surgery.

While neither decline achieved statistical significance, a risk-adjusted analysis yielded a significant reduction in the odds ratio after implementation of the program, the authors pointed out.

The program consisted of patient and family education and a set of standardized electronic physician orders for early mobilization and pulmonary care.

"Any success that [this program] or similar postoperative care programs can achieve must be sustained through constant education and reeducation of staff and patients, along with regular measurements of performance and analyses of data," McAneny's group wrote.

"We are eager to monitor our outcomes over a longer period, and we are stimulated by the possibility that postoperative complications may be diminished by adherence to simple, inexpensive, easily performed patient care strategies," they added.

Postoperative pulmonary complications occur in as many as 3.5% of patients after noncardiac surgery. As defined by the National Surgical Quality Improvement Program (NSQIP), postoperative pulmonary complications include pneumonia, unplanned intubation, and failure to wean from mechanical ventilation after 48 hours.

A single-institution study conducted almost a decade ago showed that postoperative respiratory complications add $52,466 to the cost of care for each affected patient, the authors noted. As compared with other postoperative problems, such as thromboembolic and infectious complications, pulmonary complications were the most costly and associated with a 14-day increased length of stay.

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