If you are due for surgery, you may be concerned about potentially developing a postoperative pulmonary complication (PPC). While the prospect of a surgery is already daunting enough, the thought of developing another condition during the healing process can be extra stressful, especially in a post-COVID world. However, understanding more about PPCs in a world where COVID also exists can alleviate some of that excessive stress.

What are Postoperative Pulmonary Complications?

Physiopedia defines postoperative pulmonary complications (PPCs) as a range of respiratory problems that can occur following surgical procedures. These complications affect the lungs and respiratory system and can arise in the postoperative period, typically within the first few days after surgery.

Prevention and management of postoperative pulmonary complications involve several strategies, including early mobilization, breathing exercises, coughing techniques, pain management, and appropriate antibiotic prophylaxis. In some cases, supplemental oxygen, respiratory therapies, or targeted interventions may be necessary.

It’s important to note that the risk of postoperative pulmonary complications can vary depending on factors such as the type of surgery, underlying health conditions, age, and smoking history. Surgical teams closely monitor patients during the postoperative period to identify and manage these complications promptly.

What are the connections between PPCs and post-Covid recovery?

According to a study published in the National Library of Medicine, postoperative pulmonary complications (PPCs) can be particularly relevant in the context of COVID-19 due to several reasons:

1. Increased Vulnerability.

COVID-19 is primarily a respiratory illness caused by the SARS-CoV-2 virus. Individuals who have recently undergone surgery may have compromised respiratory function and a higher vulnerability to respiratory infections, including COVID-19.

2. Impact on Postoperative Recovery.

COVID-19 can affect the overall health and recovery of surgical patients. The virus can lead to systemic symptoms, respiratory distress, and organ dysfunction, which can impede the healing process and increase the risk of developing PPCs.

3. Respiratory Complications.

COVID-19 can cause severe respiratory complications, such as pneumonia, acute respiratory distress syndrome (ARDS), and respiratory failure. Surgical patients who contract COVID-19 are at an increased risk of developing these complications, which can significantly impact their postoperative course and outcome.

4. Anesthetic Considerations.

Anesthesia can affect respiratory function and increase the risk of PPCs. COVID-19 may pose additional challenges related to anesthesia management, such as the need for personal protective equipment (PPE), modifications in airway management techniques, and considerations for minimizing aerosol generation during intubation.

5. Delay or Cancellation of Surgeries.

During the COVID-19 pandemic, there have been instances of delays or cancellations of elective surgeries to preserve healthcare resources and reduce the risk of COVID-19 transmission. These delays can lead to prolonged waiting times and potentially worsen pre-existing conditions or increase the risk of complications when the surgery is eventually performed.

Given the potential impact of COVID-19 on surgical patients, healthcare providers have implemented various strategies to mitigate the risks. These may include preoperative screening for COVID-19, risk stratification of patients, optimization of respiratory function before surgery, adherence to strict infection prevention protocols, and appropriate postoperative monitoring and management.

It’s important to note that the relationship between PPCs and COVID-19 is complex and can vary depending on factors such as the patient’s health status, the type and urgency of the surgical procedure, and the prevalence of COVID-19 in the community. Healthcare professionals closely evaluate the risks and benefits on a case-by-case basis and follow guidelines specific to their local healthcare systems and organizations.

What are some examples of PPCs?

PPCs can vary in severity and may include:

1. Atelectasis.

Atelectasis is the partial collapse or complete collapse of a lung or a portion of it. It occurs when the tiny air sacs in the lungs (alveoli) become deflated. Atelectasis is a common postoperative complication and can be caused by factors such as restricted breathing, shallow breathing, or impaired coughing due to pain or anesthesia.

2. Pneumonia.

Pneumonia is an infection of the lungs characterized by inflammation and fluid accumulation in the air sacs. Postoperative pneumonia can occur due to the aspiration of bacteria into the lungs during surgery or as a result of impaired lung function, decreased mobility, or weakened immune response after surgery.

3. Pulmonary Edema.

Pulmonary edema refers to the accumulation of fluid in the lungs, leading to impaired oxygen exchange. It can occur as a complication of certain surgeries, such as cardiac or major abdominal procedures. Pulmonary edema may result from fluid overload, heart dysfunction, or a disruption in the balance of fluids and electrolytes.

4. Respiratory Failure.

Respiratory failure occurs when the respiratory system is unable to meet the body’s oxygenation and ventilation needs. It can manifest as either hypoxemic respiratory failure (inadequate oxygen supply to the tissues) or hypercapnic respiratory failure (elevated carbon dioxide levels). Postoperative respiratory failure can be caused by various factors, including underlying lung disease, anesthesia-related effects, or complications such as pneumonia or atelectasis.

5. Pleural Effusion.

Pleural effusion refers to the buildup of fluid between the layers of tissue lining the lungs and chest cavity (pleura). It can occur following surgery due to increased fluid production or impaired drainage, leading to breathing difficulties and discomfort.

6. Bronchospasm.

Bronchospasm involves the sudden constriction or tightening of the airway muscles, leading to narrowed air passages and difficulty breathing. It can occur as a result of inflammation, irritants, or hypersensitivity reactions. Certain surgeries, particularly those involving the airways or chest, can trigger bronchospasm.

What can doctors do to minimize risks of PPCs in a post-COVID world?

In the post-COVID world, healthcare providers have implemented several measures to ensure the safety of surgical procedures and reduce the risk of COVID-19 transmission. Here are some key strategies being employed:

1. Preoperative Screenings.

Patients scheduled for surgery are often screened for COVID-19 before the procedure. This may involve assessing symptoms, conducting COVID-19 tests (such as PCR or antigen tests), and reviewing the patient’s exposure history.

2. Risk Stratification.

Healthcare providers evaluate the risks and benefits of performing surgery for each patient, considering factors such as the urgency of the procedure, the patient’s health status, and the local prevalence of COVID-19. Urgent or emergent surgeries are typically prioritized, while elective procedures may be postponed or rescheduled to minimize the risk of COVID-19 exposure.

3. Infection Prevention Protocols.

Strict infection control protocols are followed in surgical settings. “This includes the use of personal protective equipment (PPE) by healthcare providers, such as masks, face shields, gloves, and gowns.” Source: https://pubmed.ncbi.nlm.nih.gov/32315451.

Enhanced cleaning and disinfection measures are implemented in operating rooms and other areas to maintain a safe environment.

4. Modified Anesthesia Practices.

Anesthesia management may be modified to minimize the risk of COVID-19 transmission. This may include using regional anesthesia techniques when suitable, avoiding nebulized medications, and utilizing specific intubation and extubation protocols to reduce aerosol generation and enhance safety.

5. Postoperative Monitoring and Care.

Patients are closely monitored in the postoperative period, and appropriate care is provided to ensure optimal recovery. This may involve monitoring for signs and symptoms of COVID-19, managing pain and respiratory function, and facilitating early mobilization to prevent postoperative complications.