Background

Postoperative pulmonary complications after major abdominal surgery are frequent and carry high morbidity and mortality. Early identification of patients at risk of pulmonary complications by lung ultrasound may allow the implementation of preemptive strategies. The authors hypothesized that lung ultrasound score would be associated with pulmonary postoperative complications. The main objective of the study was to evaluate the performance of lung ultrasound score on postoperative day 1 in predicting pulmonary complications after major abdominal surgery. Secondary objectives included the evaluation of other related measures for their potential prediction accuracy.

Methods

A total of 149 patients scheduled for major abdominal surgery were enrolled in a bicenter observational study. Lung ultrasound score was performed before the surgery and on days 1, 4, and 7 after surgery. Pulmonary complications occurring before postoperative day 10 were recorded.

Results

Lung ultrasound score on postoperative day 1 was higher in patients developing pulmonary complications before day 10 (median, 13; interquartile range, 8.25 to 18; vs. median, 10; interquartile range, 6.5 to 12; Mann–Whitney P = 0.002). The area under the curve for predicting postoperative pulmonary complications before day 10 was 0.65 (95% CI, 0.55 to 0.75; P = 0.003). Lung ultrasound score greater than 12 had a sensitivity of 0.54 (95% CI, 0.40 to 0.67), specificity of 0.77 (95% CI, 0.67 to 0.85), and negative predictive value of 0.74 (95% CI, 0.65 to 0.83). Lung ultrasound score greater than 17 had sensitivity of 0.33 (95% CI, 0.21 to 0.47), specificity of 0.95 (95% CI, 0.88 to 0.98), and positive predictive value of 0.78 (95% CI, 0.56 to 0.93). Anterolateral lung ultrasound score and composite scores using lung ultrasound score and other patient characteristics showed similar predictive accuracies.

Conclusions

An elevated lung ultrasound score on postoperative day 1 is associated with the occurrence of pulmonary complications within the first 10 days after major abdominal surgery.

Editor’s Perspective
What We Already Know about This Topic
  • Postoperative pulmonary complications after major abdominal surgery are common, contributing to heightened morbidity and mortality.
  • The early identification of patients at risk of pulmonary complications through lung ultrasound may facilitate the implementation of preemptive strategies. However, the predicting value remains to improve, and obtaining classic lung ultrasound evaluation is challenging.
What This Article Tells Us That Is New
  • The article introduces a novel perspective by highlighting that the lung ultrasound score, acquired on postoperative day 1, possesses predictive value for the occurrence of postoperative pulmonary complications within 10 days after major abdominal surgeries.
  • Furthermore, the anterolateral lung ultrasound score demonstrates a comparable predictive capability to that of a traditional ultrasound examination. Notably, this anterolateral approach eliminates the need to reposition the patient for posterior image acquisition, streamlining the assessment process.