Meng HJ, Chen ZH, Nie GM, Ji ZS, Wang YJ, Hu YF, Tang J. Epidemiology and risk of pulmonary complications following hepatobiliary surgical procedures: A retrospective study. World J Gastrointest Surg 2025; 17(9): 109631 [DOI: 10.4240/wjgs.v17.i9.109631]
Corresponding Author of This Article
Jing Tang, Department of Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. tja00149@btch.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui-Jie Meng, Zhao-Shuai Ji, Jing Tang, Department of Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China
Zhong-Hao Chen, THiFLY Research, Tsinghua University, Beijing 102218, China
Guang-Meng Nie, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China
Yu-Jie Wang, Medical Data Science Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China
Yong-Fang Hu, Department of Clinical Pharmacy, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Co-corresponding authors: Yong-Fang Hu and Jing Tang.
Author contributions: Meng HJ drafted manuscript; Meng HJ and Chen ZH collected data; Nie GM and Ji ZS guide research development and revised the manuscript; Wang YJ analyzed data; Hu YF designed the study and revised the article; Tang J performed the research and revised the manuscript; Hu YF and Tang J contributed equally to this manuscript as co-corresponding authors; and all authors have reviewed and approved the final manuscript.
Supported by the Beijing Tsinghua Changgung Hospital Fund, China, No. 12023C01005.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Beijing Tsinghua Changgung Hospital, Affiliated with Tsinghua University, No. 23643-0-01.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data to support the findings of this study are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Tang, Department of Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. tja00149@btch.edu.cn
Received: May 19, 2025 Revised: June 6, 2025 Accepted: August 1, 2025 Published online: September 27, 2025 Processing time: 131 Days and 3.1 Hours
Abstract
BACKGROUND
Postoperative pulmonary complications (PPCs) are the most common complications following major upper abdominal surgeries, particularly hepatobiliary procedures, and significantly compromise surgical outcomes and patients’ quality of life. Although the adoption of laparoscopy has lowered their incidence, PPCs remain a frequent and serious concern after hepatobiliary surgery. Existing research on risk factors specific to hepatobiliary surgeries is limited, particularly regarding the epidemiology and risk factors of PPCs in liver and gallbladder surgeries in China. Therefore, this study aimed to investigate the risk factors for PPCs in a large hepatobiliary center.
AIM
To identify the incidence and risk factors for PPCs following hepatobiliary surgery based on perioperative variables.
METHODS
Retrospective data were collected from patients who underwent liver, gallbladder, or pancreatic surgery at a hepatobiliary center in China between May 2023 and December 2023. We retrospectively reviewed comprehensive medical records to extract demographic and hospital admission information for determining PPC incidence. Statistically significant variables were initially screened through univariate analysis, followed by binary logistic regression modeling to identify independent predictors of PPCs. Hospitalization expenditures and duration of stay were further contrasted across the study cohorts.
RESULTS
This study included 1941 patients who underwent liver, gallbladder, or pancreatic surgery, of whom 78 developed PPCs, resulting in an incidence rate of 4.02%. Logistic regression analysis revealed two independent predictors of PPCs in hepatobiliary surgery patients: Age ≥ 75 year (odds ratio = 8.350, 95%CI: 3.521-19.798, P < 0.001) and prolonged anesthesia (odds ratio = 1.052, 95%CI: 1.015-1.091, P = 0.006). Patients with PPCs had significantly elevated healthcare resource utilization, including higher total hospitalization costs, increased medication expenses, longer hospital stays, and extended postoperative admissions (all P < 0.001).
CONCLUSION
Age ≥ 75 years and prolonged anesthesia emerged as independent predictors of PPCs following hepatobiliary surgery. These complications were correlated with protracted hospitalization and increased healthcare costs.
Core Tip: This study identifies two independent risk factors for postoperative pulmonary complications (PPCs) following hepatobiliary surgery: Age ≥ 75 years and prolonged anesthesia. Conducted in a large Chinese hepatobiliary center, the retrospective analysis of 1941 patients revealed an incidence rate of PPCs at 4.02%. Patients with PPCs experienced significantly higher hospitalization costs, medication expenses, and longer lengths of stay compared to those without complications. These findings underscore the need for targeted interventions to mitigate PPCs in high-risk populations and improve surgical outcomes.
Citation: Meng HJ, Chen ZH, Nie GM, Ji ZS, Wang YJ, Hu YF, Tang J. Epidemiology and risk of pulmonary complications following hepatobiliary surgical procedures: A retrospective study. World J Gastrointest Surg 2025; 17(9): 109631
Postoperative pulmonary complications (PPCs) after hepatobiliary surgery are common and serious complications that significantly increase postoperative incidence and mortality rates. Research has shown that the incidence of PPCs is relatively high after liver and gallbladder surgeries, particularly in patients undergoing liver resection, where the incidence of PPCs can be as high as 5%-20%[1-3]. The mortality rate can reach up to 15.65%[4] among patients who develop severe pulmonary complications, such as bronchopleural fistula, following liver and gallbladder surgery. These complications prolong hospitalization and increase medical costs[5], which have a serious negative impact on the patient's recovery and prognosis.
Integrating noninvasive ventilation and early mobilization strategies may effectively reduce the risk of PPCs. Reports indicate that non-invasive positive pressure ventilation accelerates lung function recovery and prevents and treats PPCs through non-invasive positive pressure ventilation[6]. Particularly in the post-cardiotomy setting, this intervention markedly decreases the occurrence of acute cardiopulmonary failure (risk ratio: 0.35)[7,8]. Additionally, respiratory training combined with motivational spirometer training significantly reduces complications such as atelectasis and shortens hospital stay[9]. In addition to respiratory training, other methods such as early return to routine lifestyle may alleviate intensive care unit-acquired muscle weakness, improve survival rates, and reduce functional impairment[10]. Through multimodal interventions, these innovative nursing strategies enhance postoperative lung function.
Previous studies have done some research on high-risk factors for pulmonary complications after liver and gallbladder surgeries. Older age, comorbidities with chronic obstructive pulmonary disease (COPD), preoperative pulmonary dysfunction, longer surgery time, excessive intraoperative blood transfusion, postoperative delirium, and pleural adhesions are potential high-risk factors for PPCs[11-14]. Most existing studies have focused on advancements in surgical techniques and perioperative management strategies; however, systematic research on high-risk factors for pulmonary complications remains limited. Evidences have shown several deficiencies in key areas: (1) Absence of reports on predictive factors specific to hepatobiliary surgical procedures; (2) Inadequate comprehensive evaluation of multidimensional risk determinants encompassing comorbidities, surgical techniques, anesthesia duration, and perioperative fluid administration protocols[15,16]; and (3) Limited incorporation of emerging risk variables, particularly those associated with postoperative pain control methodologies. To address the above, this study aims to evaluate patients undergoing hepatobiliary surgery in a large hepatobiliary center in China, and compare risk factors before, during, and after surgery for collating a comprehensive data of patients. Additionally, novel assessment factors such as pain scores will be incorporated. Finally, the outcome of this study aims to improve patient prognosis and reduce healthcare costs through enabling preemptive recognition of at-risk individuals and timely intervention.
MATERIALS AND METHODS
Patients
We performed a retrospective analysis utilizing the hospital’s case system and collected data on patients admitted to the hepatobiliary and pancreatic departments of Beijing Tsinghua Changgung Hospital between May 2023 and December 2023. The inclusion criteria were: (1) Perioperative patients undergoing liver, biliary and pancreatic surgery; and (2) Age ≥ 18 years. The exclusion criteria were: (1) Diagnosis of PPCs before surgery; (2) Pregnant or lactating women; and (3) Patients with incomplete information. Study participants were stratified by PPC occurrence (non-PPC vs PPC groups). After 3:1 matching of PPC patients with surgical procedure-matched controls, cohorts underwent high-risk factor verification.
The demographic characteristics of the two patient groups were recorded, including age, sex, height, weight, body mass index (BMI), smoking history, and American Society of Anesthesiologists (ASA) score. Recorded comorbidities included hypertension, diabetes, COPD, hepatitis B virus (HBV) infection, cirrhosis, heart failure, and a history of stroke. Data including surgical type, anesthesia duration, intraoperative fluid administration, and blood transfusion volume were recorded. For hepatobiliary surgeries, general anesthesia was uniformly employed, and induction was achieved using intravenous anesthetics (e.g., propofol and etomidate) combined with neuromuscular blocking agents (e.g., rocuronium and cisatracurium) and opioids (e.g., fentanyl and sufentanil). Anesthesia is maintained using inhaled agents (e.g., sevoflurane and desflurane) or intravenous anesthesia (e.g., propofol and remifentanil). For hepatobiliary surgeries, local anesthesia is typically administered via the injection of lidocaine or ropivacaine at the surgical site. General anesthesia (using the same protocol as described above) was reserved for complicated cases. This study was approved by the Ethics Review Committee of Beijing Tsinghua Changgung Hospital, approval No. 23643-0-01.
Definition and data collection
PPCs were defined according to the criteria established by the European Society of Anesthesiology[17] and relevant literature[18,19] related to liver and gallbladder surgeries. A diagnosis of PPCs required meeting at least one of the criteria described in Table 1. Based on current research[19-21] and clinical experience, demographic profiles encompassing age, sex, anthropometrics (height, weight, BMI), tobacco use status, and ASA physical classification were documented for both cohorts. Pre-existing conditions systematically captured included cardiovascular disorders (hypertension, heart failure), metabolic disease (diabetes), respiratory impairment (COPD), hepatobiliary pathologies (HBV seropositivity, cirrhosis), and cerebrovascular events (stroke history).
Table 1 Incidence of postoperative pulmonary complications in this study.
Statistical analyses were performed using SPSS 23.0 and R4.5.0. Continuous variables are expressed as mean ± SD or median (interquartile range), and categorical variables as frequencies (percentages). Intergroup comparisons employed Student’s t-test or Mann-Whitney U test for continuous measures, and χ² or Fisher’s exact tests for categorical measures. Univariate followed by multivariate logistic regression modeling generated odds ratios with 95% confidence intervals. Variables demonstrating P < 0.05 in univariate screening were incorporated into the multivariate regression. Propensity score matching was performed using logistic regression with the PPC group as the reference. We set a caliper value of 0.01 and conducted 1:3 matching with the control group, using sex, BMI, smoking status, and surgical type as matching variables. Statistical significance was defined as P < 0.05. As this study did not apply multiple comparisons, observed P values were reported.
RESULTS
Incidence of pulmonary complications after hepatobiliary surgery
Between May 2023 and December 2023, a total of 1941 patients underwent hepatobiliary and pancreatic surgery. Among them, 78 experienced PPCs, with an incidence rate of 4.02%. In this study, patients in the non-PPC group were matched at a 1:3 ratio with those in the PPC group. Propensity score matching did not find any statistically significant differences between the two groups in terms of sex (P > 0.05), BMI (P > 0.05), smoking status (P > 0.05), or surgical type (P > 0.05). A research cohort was established to investigate the risk factors of postoperative complications, and the clinical characteristics of the two groups were compared and analyzed (Figure 1). The specific details of the complications are presented in Table 1. Of these, 56 (71.8%) were men and 22 (28.2%) were women. Study participants had a median age of 63 years (range: 24-90) with median BMI at 22.0 kg/m2 (range: 16.2-34.7). A total of 34 (43.6%) patients were classified as ASA grade III-IV.
Figure 1 Study flowchart for risk factor analysis.
PPCs: Postoperative pulmonary complications.
Baseline patients’ characteristics
Table 2 delineates comparative baseline characteristics between non-PPC and PPC groups. Demographics factors-including sex, height, weight, BMI, smoking history, hypertension, HBV infection, liver cirrhosis, heart failure, and stroke-were similar between the two groups. Patients with PPCs had significantly increased mean albumin (34.30 g/L vs 37.88 g/L, P < 0.001), median total bilirubin (17.8 U/L vs 13.8 U/L, P = 0.038), direct bilirubin (11.4 U/L vs 6.6 U/L, P = 0.002), aspartate aminotransferase (43.35 U/L vs 29.0 U/L, P = 0.002), and alanine aminotransferase (41.9 U/L vs 24.8 U/L, P = 0.003).
Table 2 Comparison of baseline characteristics between the non-postoperative pulmonary complication and postoperative pulmonary complication groups, n (%).
The types of liver and gallbladder surgeries performed at our hospital during the study period mainly included interventional surgery (percutaneous arterial embolization, angiography, or catheterization), liver surgery (liver segment or partial resection), and laparoscopic surgery (gallbladder, liver, or intestine). A comparison of the patients’ intraoperative and postoperative conditions is shown in Table 3. Univariate analysis revealed that patients who underwent liver surgery (P < 0.001) or laparoscopic surgery (P < 0.001) were more prone to PPCs. Patients with ASA grade III or IV (P < 0.001), surgery time ≥ 2 hours (P < 0.001), blood loss ≥ 100 mL (P < 0.001), and blood transfusion (P < 0.001) are more likely to develop PPCs. The PPC group had longer anesthesia time (P < 0.001) and more infusion volume (P < 0.001).
Table 3 Intraoperative and postoperative factors in the non-postoperative pulmonary complication and postoperative pulmonary complication groups, n (%).
Variable
PPC (n = 78)
Non-PPC (n = 234)
P value
Intraoperative factors
ASA physical status
III-IV
34 (43.59)
51 (21.8)
< 0.001
Operation duration ≥ 2 hours
45 (57.7)
78 (33.3)
< 0.001
Anesthesia duration (10 minutes)
572.18 ± 226.41
252.98 ± 222.71
< 0.001
Estimated blood loss ≥ 100 mL
38 (48.7)
38(16.2)
< 0.001
Blood transfusion
19 (24.4)
11 (4.7)
< 0.001
Infusion (mL)
4550.16 ± 2239.36
2320.70 ± 1957.34
< 0.001
Surgical procedure
Interventional surgery (percutaneous arterial embolization/angiography/catheterization)
34 (43.6)
110 (47.0)
0.6
Liver surgery (liver segment/partial resection)
25 (32.1)
76 (32.48)
0.944
Laparoscopic surgery (gallbladder/Liver/intestine)
Univariate correlation analysis identified several variables significantly associated with the occurrence of PPCs. These included age (P = 0.03), preoperative albumin level (P < 0.001), total bilirubin (P = 0.038), direct bilirubin (P = 0.002), aspartate aminotransferase (P = 0.002), alanine aminotransferase (P = 0.003), diabetes mellitus (P = 0.001), ASA physical status III-IV (P < 0.001), operation duration (P < 0.001), anesthesia duration (P < 0.001), estimated blood loss (P < 0.001), blood transfusion (P < 0.001), infusion volume (P < 0.001). The absolute risk reduction of clinical factors with significant differences found in the univariate analysis is shown in Figure 2A. For continuous variables, use the average as the classification boundary to absolute risk reduction calculation. We incorporated the aforementioned factors into a binary logistic regression analysis, along with the significant high-risk factors reported in the literature: Smoking history, obesity (BMI ≥ 28), and preoperative anemia (hemoglobin ≤ 100 g/L). In the date analysis, we used the method of exclusion of missing data to compute for the missing data, and the exclusion ratio was 0.6%. The results indicated that age (OR = 8.350, 95%CI: 3.521-19.798, P < 0.001) and duration of anesthesia (OR = 1.052, 95%CI: 1.015-1.091, P = 0.006) were the independent factors influencing PPCs following hepatobiliary surgery, as shown in Figure 2B.
Figure 2 Risk factors analysis.
A: Forest plot of the absolute risk reduction of clinical factors with significant differences in univariate analysis; B: Forest plot of the multivariable analysis for risk factors of postoperative pulmonary complications. OR: Odds ratio; CI: Confidence interval; AST: Aspartate aminotransferase; TBIL: Total bilirubin; BMI: Body mass index; ASA: American Society of Anesthesiologists; HGB: Hemoglobin.
Hospitalization duration and healthcare expenses
We compared the hospitalization duration and medical costs between patients who developed PPCs and those who did not. Results demonstrated significantly prolonged hospitalization durations (including postoperative stays) and elevated medical expenditures (total hospitalization and medication costs) in the PPC cohort relative to the non-PPC group, with all differences reaching statistical significance (P < 0.001). Further details are provided in Table 4.
Table 4 Hospital length of stays and healthcare cost burden among patients.
PPCs significantly impact patient prognosis following hepatobiliary surgery. Studies have reported that the incidence of PPC after hepatectomy and biliary reconstruction is 2%-12%[22,23]. Severe PPCs can result in extended hospital stays, increased medical costs, and elevated mortality risk[24,25]. Airway management is crucial to rapid recovery after surgery, and numerous studies have addressed this issue[5,25-27]. The influencing factors outlined in the relevant Chinese guidelines are largely based on research on thoracic surgery. Some studies have focused on the high-risk factors for PPCs in hepatectomy and liver transplantation. However, given the multitude of influencing factors that may be impractical to apply in clinical settings, this study targeted patients undergoing hepatobiliary surgery-without subdividing by surgical types-to enhance clinical applicability and relevance to this population.
In patients undergoing biliary surgery, postoperative respiratory suppression due to incision pain or weakened cough, particularly in older patients, can result in sputum retention and subsequent infection[27,28]. Furthermore, ischemia-reperfusion injuries resulting from hepatic portal occlusion during liver resection may indirectly impair lung function and increase the risk of complications through inflammatory responses[29,30]. Consequently, identifying the high-risk factors for PPCs is crucial for effective clinical interventions. In this study, the univariate analysis revealed that 17 clinical factors influenced PPCs. Logistic regression analysis further identified unmodifiable (patient age) and potentially modifiable risk factors (duration of anesthesia) as significant predictors of PPCs in patients undergoing hepatobiliary surgery. Specifically, patients aged ≥ 75 years exhibited a six-fold increase in PPCs incidence compared with other adult patients. Moreover, for every 10 minutes-increase in anesthesia duration, the risk of developing PPCs rose by 5.2%.
With aging, the elasticity of the lung tissue diminishes, alveolar surface area decreases, and respiratory muscle strength weakens-all of which contribute to a decline in pulmonary reserve[13,31]. Our study revealed a marked elevation in PPC incidence among patients aged ≥ 75, primarily encompassing pleural effusion, atelectasis, and respiratory failure. The underlying causes encompass the following factors: (1) Physiological decline in the elderly, including reduced lung elasticity, impaired cough reflex, and difficulty in sputum excretion[32-34]; (2) The presence of comorbidities including COPD, diabetes, and hypertension, which further elevate the risk of postoperative pulmonary infection and respiratory failure[35-37]; and (3) Delayed postoperative recovery. Older patients exhibit lower pain threshold, potentially inhibiting effective coughing and early mobilization, thereby prolonging bed rest and augmenting the risk of sputum retention and infection[27,38]. Numerous studies have found that advanced age as a significant risk factor for PPCs[28,39,40], emphasizing the importance of heightened vigilance in older patients. Clinical management should emphasize preoperative lung function optimization, meticulous intraoperative anesthesia control, and early postoperative rehabilitation. These efforts should be accompanied by timely assessment and prompt intervention for respiratory tract abnormalities.
In this study, the incidence of PPCs correlated with anesthesia duration, aligning with previous findings[18,33]. Hepatobiliary surgeries typically require general anesthesia and mechanical ventilation, and prolonged ventilation can lead to ventilator-associated lung injury, including barotrauma[41]. The prolonged administration of volatile anesthetics or opioids may suppress the cough reflex and ciliary clearance mechanisms[42], thereby elevating pulmonary infection risks. Furthermore, an extended anesthesia duration may result in fluid accumulation, exacerbating pulmonary interstitial edema and impairing oxygenation[5]. As anesthesia time increases, these factors collectively heighten the risk of PPCs in patients undergoing hepatobiliary surgeries. Additionally, an analysis of surgical factors revealed that the proportions of patients in the PCC group who underwent anesthesia grade III-IV surgeries (43.59% vs 21.8%, P < 0.001), surgeries lasting ≥ 2 hours (57.7% vs 33.3%, P < 0.001), experienced blood loss ≥ 100 mL (48.7% vs 16.2%, P < 0.001), required blood transfusion (24.4% vs 4.7%, P < 0.001), and received an infusion volume (4550.16 vs 2320.70 mL, P < 0.001) were all significantly higher in PCC group. Although these factors were not identified as high-risk predictors of PPCs in the binary logistic regression analysis, they suggest that increased surgical complexity, longer duration, greater intraoperative blood loss, higher infusion volume, and the need for transfusion may contribute to the occurrence of PPCs postoperatively.
Previous studies have demonstrated that smoking substantially increases the risk of PPCs by impairing ciliary function, increasing airway secretions, and reducing lung function, thereby hindering postoperative pulmonary recovery[33,43]. In this study, no significant difference was observed in smoking status between the PPC and non-PPC groups (10% vs 11%, P = 0.834). This may be attributed to the weak correlation between the disease location and smoking status, suggesting that smoking may not be a critical factor in postoperative airway care for patients at this medical center. Furthermore, although smoking status was no significant difference between the two groups in this study, patients were still advised to quit smoking based on findings from studies involving other surgical procedures.
Further analyses were conducted to identify other confounding factors including BMI and preoperative pulmonary function. Our results showed that no significant difference in BMI between the two groups. This may be due to the nonlinear relationship between BMI and PPCs, which were not addressed through a subgroup stratification in this study. Studies have revealed an association between BMI and PPCs[44], with the lowest risk observed at a BMI of 27.4 kg/m². Patients who are overweight (BMI: 25.0-29.9 kg/m²) and those with class I obesity (BMI: 30.0-34.9 kg/m²) exhibited lower PPCs risk than normal-weight individuals. Therefore, although BMI was not found as a high-risk factor in this research, monitoring patient BMI-particularly in underweight individuals-remains clinically recommended. Regarding preoperative pulmonary function, studies indicate that preoperative SpO2 < 94% and abnormal forced expiratory volume in 1 second/forced vital capacity ratios correlate with increased PPCs risk[13,45]. Direct pulmonary function data were unavailable in this study; therefore, preoperative COPD status was evaluated. The results of this study showed that there was no significant difference in the prevalence of COPD among the groups. Considering existing evidence, we suggested that institutions with adequate resources should implement preoperative SpO2 and forced expiratory volume in 1 second/forced vital capacity assessments. Critical values necessitates enhanced postoperative pulmonary monitoring.
In the realm of pharmacoeconomics, this study revealed that patients with PPCs had significantly extended hospital stays, extended postoperative stays, and higher total hospitalization and medication expenses compared to the non-PPC patients. These findings underscore the economic significance of research on effective airway management in mitigating PPCs. According to data published in the Journal of the American Medical Association[22], approximately 100000 cases of PPCs occur annually in the United States, resulting in an additional 480000 hospital days. Studies have shown that 40.5% of adverse events in hospitalized patients are surgery-related, emphasizing the need to identify at-risk individuals and implement appropriate preoperative interventions[23]. PPCs significantly prolonged hospitalization. Some studies have reported a median hospital stay of 15 days for patients with PPCs, compared to 7 days for those without complications[46]. This extension directly leads to increased hospitalization expenses. Data suggest that PPCs are associated with an average increase of approximately 40% in healthcare expenses[47]. These complications impact healthcare economics through multiple pathways, reinforcing the need for preventive measures and early interventions to ensure significant economic benefits.
This study has some limitations. It is a single-center retrospective analysis, which may limit the promotion of the conclusion of this study. The data in this study did not include some respiratory function parameters during the perioperative period, such as respiratory rate, tidal volume, and inhaled oxygen concentration. The absence of these data may have led to the omission of relevant risk factors and an underestimation of the true incidence of PPC. The generalizability of the conclusions of this study is as follows: This study was conducted at a Hepatobiliary Center with in a major tertiary care hospital, where clinical practice strictly adheres to international guidelines, supporting the generalizability of our findings. Furthermore, baseline characteristics and outcome incidences in our cohort align with existing domestic and international studies, reinforcing the broader applicability of our study population. While immediate extrapolation requires caution, core findings-particularly age ≥ 75 years and anesthesia duration-align with multicenter studies, supporting plausibility beyond our center.
CONCLUSION
In conclusion, PPCs following hepatobiliary surgery significantly affect length of stays and the associated medical costs. The data summarized in this article may help improve understanding of the complications and high-risk factors associated with pulmonary disease after hepatobiliary surgery. We identified two independent risk factors for PPCs in patients after hepatobiliary surgery: Age ≥ 75 years and prolonged anesthesia duration. Scheduled patient assessment should be implemented to minimize anesthesia duration and mitigate PPC risks. Enhanced postoperative pulmonary surveillance is essential for patients aged > 75 years and those under prolonged anesthesia. Tailored surveillance strategies towards the detection of early symptoms are critical to prevent progression to severe complications such as pneumonia and respiratory failure.
ACKNOWLEDGEMENTS
We would like to express our gratitude to Professor Liu YW for his contribution to data analysis and to Professor Yan Y for her contribution to paper revisions.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B
Novelty: Grade C
Creativity or Innovation: Grade C
Scientific Significance: Grade B
P-Reviewer: Zhang XJ, MD, Assistant Professor, China S-Editor: Bai Y L-Editor: A P-Editor: Yu HG
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