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.