Effects of Pain on Postoperative Pulmonary Complications
Name: Kerry Hickey-Cheever
Rank: CDR, USNR
Organization: Marquette University
Performance Site: Marquette University College of Nursing, Emory Clark Hall, Milwaukee, WI; St. Michael Hospital, Milwaukee, WI
Year Published: 1997
Abstract Status: Final
Postoperative pulmonary complications (PPCs) are the major cause of morbidity and mortality among all postoperative thoracic and abdominal surgical patients who have general anesthesia. Although the incidence of PPCs has not been measured specifically among military surgical patients, these lethal complications could potentially exact a heavy toll on battle casualties with chest and abdominal injuries. Of the PPC risk factors noted in Brooks-Brunn's PPC Risk Model, anticipating and treating these patients' acute postoperative pain is a risk factor most amenable to tertiary-based nursing intervention.Although the Agency for Health Care Policy and Research (AHCPR) published definitive guidelines that can readily be utilized by clinicians to minimize acute postoperative pain, clinical pain experts assert that postoperative patients continue to be undermedicated. Therefore, the purpose of this study was to investigate the effects of acute pain and amount and method of opioids administered on pulmonary restrictive dysfunction and morbidity among postoperative thoracic and abdominal surgical patients who had general anesthesia.Chart audit data, lung sound assessments, and spirometric data were prospectively assessed on a convenience sample of thoracic and abdominal surgical inpatients admitted to an urban Midwestern civilian hospital postoperatively (n = 101). Multiple regression analysis revealed that increasing pain, older age at surgery, having thoracic rather than abdominal surgery, having a transverse incision, and being overweight were positively associated with postoperative pulmonary restrictive dysfunction. Logistic regression analysis revealed that increasing age, smoking cigarettes, having abdominal rather than thoracic surgery, having a longitudinal incision, not having a nasogastric tube, and not being overweight increased the odds of having pulmonary morbidity. Postoperative opioids dose and method of opioids delivery (preemptive versus "as needed") were not associated with either pulmonary dysfunction or morbidity.These results suggest a different risk profile for postoperative pulmonary restrictive dysfunction than actual postoperative pulmonary morbidity. It may be that the genesis of postoperative pulmonary morbidity is not purely attributable to postoperative "splinting" of respiratory effort. The findings that opioid dose and method of delivery were not associated with either postoperative pulmonary dysfunction or morbidity could be attributed to the overall low doses of opioids reported effective at keeping patients' pain tolerable with subsequent pulmonary restriction and dysfunction. In addition, the relationship between postoperative restrictive dysfunction and morbidity should be more closely examined.