{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:27:31Z","timestamp":1772159251715,"version":"3.50.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Postoperative pulmonary complications (PPCs) are an important cause of perioperative morbidity and mortality. Although risk factors for PPCs have been identified in high-income countries, less is known about PPCs and their risk factors in low- and middle-income countries, such as South Africa. This study examined the incidence of PPCs and their associated risk factors among general surgery patients in a public hospital in the province of KwaZulu-Natal, South Africa to inform future quality improvement initiatives to decrease PPCs in this clinical population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective secondary analysis of adult patients with general surgery admissions from January 1, 2013 to December 31, 2017 was conducted using data from the health system\u2019s Hybrid Electronic Medical Registry. The sample was comprised of 5352 general surgery hospitalizations. PPCs included pneumonia, atelectasis, acute respiratory distress syndrome, pulmonary edema, pulmonary embolism, prolonged ventilation, hemothorax, pneumothorax, and other respiratory morbidity which encompassed empyema, aspiration, pleural effusion, bronchopleural fistula, and lower respiratory tract infection. Risk factors examined were age, tobacco use, number and type of pre-existing comorbidities, emergency surgery, and number and type of surgeries. Bivariate and multivariable logistic regression models were conducted to identify risk factors for developing a PPC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The PPC rate was 7.8%. Of the 418 hospitalizations in which a patient developed a PPC, the most common type of PPC was pneumonia (52.4%) and the mortality rate related to the PPC was 11.7%. Significant risk factors for a PPC were increasing age, greater number of comorbidities, emergency surgery, greater number of general surgeries, and abdominal surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>PPCs are common in general surgery patients in low- and middle-income countries, with similar rates observed in high-income countries. These complications worsen patient outcomes and increase mortality. Quality improvement initiatives that employ resource-conscious methods are needed to reduce PPCs in low- and middle-income countries.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0274749","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T17:23:12Z","timestamp":1665508992000},"page":"e0274749","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Identification of risk factors for postoperative pulmonary complications in general surgery patients in a low-middle income country"],"prefix":"10.1371","volume":"17","author":[{"given":"Katelyn","family":"Morris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kylie","family":"Weston","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Davy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6368-4732","authenticated-orcid":true,"given":"Susan","family":"Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Goode","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Brysiewicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Bruce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damian","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,10,11]]},"reference":[{"issue":"7","key":"pone.0274749.ref001","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/01.NPR.0000431179.49311.0b","article-title":"Postoperative pulmonary complications: reducing risks for noncardiac surgery","volume":"38","author":"J Thanavaro","year":"2013","journal-title":"Nurse Pract"},{"issue":"2","key":"pone.0274749.ref002","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.suc.2014.11.002","article-title":"Prevention of postoperative pulmonary complications","volume":"95","author":"A Taylor","year":"2015","journal-title":"Surg Clin North Am"},{"issue":"Supply 1","key":"pone.0274749.ref003","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/anae.14137","article-title":"Respiratory complications of anaesthesia","volume":"73","author":"GH Mills","year":"2018","journal-title":"Anaesthesia"},{"issue":"8","key":"pone.0274749.ref004","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/EJA.0000000000000659","article-title":"Postoperative pulmonary complications\u2014Still room for improvement","volume":"34","author":"G Haller","year":"2017","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"pone.0274749.ref005","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications","volume":"118","author":"A Miskovic","year":"2017","journal-title":"Br J Anaesth"},{"issue":"9","key":"pone.0274749.ref006","doi-asserted-by":"crossref","first-page":"599","DOI":"10.4103\/0019-5049.165857","article-title":"Post-operative pulmonary complications after non-cardiothoracic surgery","volume":"59","author":"KV Kelkar","year":"2015","journal-title":"Indian J Anaesth"},{"issue":"3","key":"pone.0274749.ref007","first-page":"284","article-title":"Incidence and risk factors for postoperative pulmonary complications in patients undergoing thoracic and abdominal surgeries","volume":"44","author":"AC \u00c1vila","year":"2017","journal-title":"Rev Col Bras Cir"},{"issue":"1","key":"pone.0274749.ref008","first-page":"9","article-title":"Perioperative evaluation of patients with pulmonary conditions undergoing non-cardiothoracic surgery","volume":"9","author":"G Diaz-Fuentes","year":"2016","journal-title":"Health Serv Insights"},{"issue":"8","key":"pone.0274749.ref009","doi-asserted-by":"crossref","first-page":"581","DOI":"10.7326\/0003-4819-144-8-200604180-00009","article-title":"Preoperative pulmonary risk stratification for noncardiothoracic surgery: Systematic review for the American College of Physicians","volume":"144","author":"G Smetana","year":"2006","journal-title":"Ann Intern Med"},{"key":"pone.0274749.ref010","unstructured":"Miller R, Cohen N, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. 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