Multimodal Pulmonary Evaluation for Prediction of Postoperative Pulmonary Complications in Elective Non-Thoracic Surgery: A Retrospective Study

Abstract

Background:

Postoperative pulmonary complications (PPCs) are a major contributor to perioperative morbidity and mortality, particularly in patients undergoing upper abdominal surgery. Conventional risk assessment tools rely largely on clinical parameters and may not fully capture underlying pulmonary dysfunction. A multimodal evaluation incorporating spirometry, impulse oscillometry (IOS), fractional exhaled nitric oxide (FeNO), and chest radiography may enhance predictive accuracy.

Objective:

To evaluate the individual and combined utility of spirometry, IOS, FeNO, and chest X-ray in predicting postoperative pulmonary complications in patients undergoing elective non-thoracic surgery.

Methods:

This retrospective observational study was conducted at a tertiary care center in Tamil Nadu, India, including 80 adult patients who underwent elective upper abdominal surgery between January 2024 and December 2025. Data were collected from hospital records using total sampling. Pulmonary assessment included spirometry, IOS parameters (R5, R20, R5–R20), FeNO levels, and chest X-ray findings. Statistical analysis involved univariate and multivariate logistic regression, along with ROC curve analysis to assess predictive performance.

Results:

The incidence of PPCs was 25%, with atelectasis being the most common complication (11.3%). Obstructive spirometry was significantly associated with PPCs (adjusted OR 3.10, p=0.04). Elevated peripheral airway resistance (R5–R20 >1.5) emerged as the strongest independent predictor (adjusted OR 3.85, p=0.01). Abnormal chest X-ray findings were also independently associated with increased risk (adjusted OR 3.50, p=0.02). Although higher FeNO levels showed a rising trend in PPC incidence, this was not statistically significant after adjustment. Multimodal assessment demonstrated superior predictive capability compared to individual modalities.

DOI: https://doi.org/10.52783/jchr.v16.i2.12857

Conclusion:

A multimodal pulmonary evaluation approach significantly improves prediction of PPCs in patients undergoing elective upper abdominal surgery. Peripheral airway dysfunction, obstructive ventilatory defects, and structural lung abnormalities are key independent predictors. Incorporating IOS into routine preoperative assessment may enhance risk stratification and guide targeted perioperative management.