Multifactorial Risk Assessment to Predict Postoperative Pleuropulmonary Complications following Thoracic and Abdominal Surgeries

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Postoperative pleuropulmonary complications (POPCs) (n=80). Intervention: Clinical and operative risk factors (including hypoalbuminemia, diabetes, asthma, and prolonged surgery) vs. Absence of respective risk factors. Primary outcome: Development of postoperative pleuropulmonary complications (POPCs) (OR 10.5, p=0.048).

Q: What does this research mean for the field?

Hypoalbuminemia, asthma, prolonged operative duration, and diabetes mellitus are significant independent predictors of postoperative pleuropulmonary complications in patients undergoing elective thoracic and abdominal surgeries. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Janani Akshaya Murugan; R. Balakrishnan; Dhamodharan Paul; Prabhakaran Rathinam; Saravanavasan Rajendran

doi:10.4103/japt.japt_23_26

September 1, 2026Journal of Association of Pulmonologist of Tamil NaduOpen Access

Multifactorial Risk Assessment to Predict Postoperative Pleuropulmonary Complications following Thoracic and Abdominal Surgeries

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Key result

Hypoalbuminemia is linked to ~10.5-fold higher odds of postoperative pleuropulmonary complications.

OR 10.5
P=0.048
n=80

Figures

Why the study?

Postoperative pleuropulmonary complications are a major cause of morbidity following thoracic and abdominal surgeries, and early identification of risk factors is essential for improving outcomes.

Does automated CACS measurement using AI software on non-ECG-gated chest CT provide high diagnostic agreement with manual measurement on ECG-gated coronary CTA in patients undergoing both scans?

Key Points

To evaluate the incidence of postoperative pleuropulmonary complications and identify preoperative, intraoperative, and clinical risk factors in elective thoracic and abdominal surgeries.
Prospective cohort study of 80 patients aged ≥12 years undergoing elective thoracic and abdominal surgeries at a tertiary care hospital.
Preoperative workup included clinical assessment, spirometry, serum albumin, and echocardiography, with monitoring for complications across 7 postoperative days.
Postoperative pleuropulmonary complications occurred in 23 patients (28.7%), most frequently acute respiratory failure (17.3%) and atelectasis (17.3%).
Significant independent risk factors included diabetes mellitus (P = 0.043; OR = 1.58), asthma (P = 0.048; OR = 4.2), surgery duration ≥3 h (P = 0.029; OR = 3.6), and hypoalbuminemia (P = 0.048; OR = 10.5).
Receiver operating characteristic analysis of serum albumin demonstrated an area under the curve of 0.75, with an optimal cutoff value of ≤3.7 g/dL yielding 90% sensitivity and 62% specificity.

Study Design

Type

Cohort (n=80)

Multicenter

No

Structured PICO

Does automated CACS measurement using AI software on non-ECG-gated chest CT provide high diagnostic agreement with manual measurement on ECG-gated coronary CTA in patients undergoing both scans?

P

Population

80 patients aged ≥12 years undergoing elective thoracic and abdominal surgeries, followed for 7 postoperative days.

E

Exposure

Automated Coronary Artery Calcium Score (CACS) measurement on non-ECG-gated chest CT using two different deep learning artificial intelligence software systems (Software A and Software B).

C

Comparator

Manual CACS measurement based on ECG-gated Coronary CTA performed by two experienced radiologists (reference standard).

O

Outcome

Consistency and agreement of CACS measurements (assessed via Intraclass Correlation Coefficient and Bland-Altman analysis) between the AI software systems and manual measurement.surrogate

Main Result

Odds Ratio: 10.5

p-value: p=0.048

Limitations

relatively small sample size (n = 182) may limit statistical power
inclusion of only patients who underwent both coronary CTA and chest CT may have introduced selection bias
all data were obtained from a single CT scanner model (uCT 960+), limiting generalizability
lack of external validation datasets
use of Spearman correlation analysis on a per-patient basis without considering the nested structure of plaques within patients

Implication

Deep learning AI algorithms can accurately and automatically calculate coronary artery calcium scores from non-ECG-gated chest CTs, showing excellent agreement with standard ECG-gated CTA and enabling opportunistic cardiovascular risk screening.

Abstract

Background: Postoperative pleuropulmonary complications (POPCs) are a major cause of morbidity following thoracic and abdominal surgeries. Early identification of risk factors is essential for improving outcomes. Objectives: To determine the incidence of POPCs and evaluate the association of preoperative, intraoperative, and clinical risk factors in patients undergoing elective thoracic and abdominal surgeries. Subjects and Methods: This prospective cohort study included 80 patients aged ≥12 years undergoing elective thoracic and abdominal surgeries at a tertiary care hospital. Preoperative evaluation included clinical assessment, spirometry, serum albumin, and echocardiography. Patients were followed for 7 postoperative days for the development of POPCs. Statistical analysis included univariate anal ysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: POPCs occurred in 23 patients (28.7%). The most common complications were acute respiratory failure and atelectasis (17.3% each). Significant predictors included diabetes mellitus ( P = 0.043; odds ratio [OR] =1.58), asthma ( P = 0.048; OR = 4.2), prolonged surgery duration ≥3 h ( P = 0.029; OR = 3.6), and hypoalbuminemia ( P = 0.048; OR = 10.5). ROC analysis for serum albumin showed an area under the curve of 0.75, with an optimal cutoff of ≤3.7 g/dL (sensitivity: 90%, specificity: 62%). Conclusion: POPCs are common following elective thoracic and abdominal surgeries. Hypoalbuminemia, diabetes, asthma, and prolonged surgery are key predictors. Serum albumin is a useful screening tool, and a multifactorial risk assessment approach is essential for improving postoperative outcomes.

Discussion

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Cite This Study

Murugan et al. (2026) conducted a cohort in Postoperative pleuropulmonary complications (POPCs) (n=80). Clinical and operative risk factors (including hypoalbuminemia, diabetes, asthma, and prolonged surgery) vs. Absence of respective risk factors was evaluated on Development of postoperative pleuropulmonary complications (POPCs) (OR 10.5, p=0.048). Postoperative pleuropulmonary complications occurred in 28.7% of patients, with hypoalbuminemia (OR 10.5), asthma (OR 4.2), and prolonged surgery ≥3 hours (OR 3.6) as significant predictors.

synapsesocial.com/papers/6ad34de0727baf805bb60f08 https://doi.org/10.4103/japt.japt_23_26

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Multifactorial Risk Assessment to Predict Postoperative Pleuropulmonary Complications following Thoracic and Abdominal Surgeries

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Multifactorial Risk Assessment to Predict Postoperative Pleuropulmonary Complications following Thoracic and Abdominal Surgeries

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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