Respiratory complications—including pneumonia and ventilator dependency—are among the most common complications that occur after operations. But a simple and inexpensive postoperative pulmonary care program known as "I COUGH"(SM) reduces the likelihood of those life-threatening and costly complications, researchers from Boston University Medical Center reported today at the 2012 American College of Surgeons (ACS) Annual Clinical Congress.
"Few data exist for best-practice guidelines regarding postoperative pulmonary care," explained study coauthor David McAneny, MD, FACS, associate professor of surgery, Boston University School of Medicine. "There is a lot of medical literature about ventilator-associated pneumonias, but little is written about standard postoperative pulmonary care."
Boston University Medical Center participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®). ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in private sector hospitals. Benchmark reports from this national database allow hospitals to compare their surgical outcomes and other factors to comparable patients in the other institutions participating in the program.
"The NSQIP data showed that our hospital had a greater than expected incidence of pulmonary complications, as well as venous thromboembolic complications, based upon our patients' risk factors. So we developed the I COUGH program to decrease the incidence of pulmonary complications," Dr. McAneny said.
I COUGH stands for:
•Understanding (patient and staff education)
•Getting out of bed at least three times daily
•Head of bed elevation.
"Our efforts were aimed at correcting basic nursing interventions as well as intensified patient and family education before the operation and in the immediate postoperative period," Dr. McAneny continued.
For the study, researchers compared their risk-adjusted pulmonary outcomes, which NSQIP initially reported as observed-to-expected ratios (O/E), from the one-year period prior to implementing I COUGH, with the odds ratios (OR; statistically comparable to O/E) for the one-year period following the program's implementation. The findings showed that the intervention reduced the likelihood of pneumonia after surgery (2.13 O/E versus 1.58 OR, respectively) and of unplanned intubation (2.10 O/E versus 1.31 OR, respectively) at their institution.