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February 28, 2026Annals of Rehabilitation MedicineOpen Access

Postoperative pulmonary complications occur in ~14% of cardiac surgery patients regardless of surgical category.

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Why the study?

To develop and validate a clinically actionable prediction model for postoperative pulmonary complications in cardiac surgery patients, focusing on modifiable preoperative risk factors amenable to targeted optimization.

Can a prediction model using modifiable preoperative physiological variables accurately predict postoperative pulmonary complications in adults undergoing open-chest cardiac surgery?

Population

492 adults undergoing open-chest cardiac surgery

Design

Prospective observational cohort study

Key result

Postoperative pulmonary complications occurred in 14.2% of cardiac surgery patients with no significant difference in surgical procedure categories (p=0.412).

Authors

RLRuoxi LiMTMeice TianCWC. Edward Wang

Discussion

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Overview

May guide prehabilitation via modifiable preoperative variables in cardiac surgery; extends PPC prediction models with physiological predictors.

Key Points

  • The aim is to create a prediction model for postoperative pulmonary complications in cardiac surgery, focusing on modifiable risk factors.
  • Conducted a prospective observational cohort study with 492 adults undergoing cardiac surgery.
  • Analyzed prespecified predictors including gas exchange, pulmonary function, and inspiratory muscle strength.
  • Utilized univariable and multivariable logistic regression to develop the prediction model.
  • Assessed discriminative ability using the area under the receiver operating characteristic curve.
  • 14.1% of patients developed postoperative pulmonary complications after surgery.
  • Identified five independent predictors of PPCs: elevated arterial PaCO2, oxygen desaturation, reduced gait speed, lower FEV1/FVC ratio, and diminished inspiratory muscle strength.
  • The model demonstrated an AUC of 0.86 in the training cohort and 0.87 in the validation cohort, indicating high predictive accuracy.

Structured PICO

Can a prediction model using modifiable preoperative physiological variables accurately predict postoperative pulmonary complications in adults undergoing open-chest cardiac surgery?

P
Population
492 adults undergoing open-chest cardiac surgery between August 15, 2023 and December 31, 2023
I
Intervention
Prediction model based on five modifiable preoperative risk factors (arterial PaCO2, oxygen desaturation [SpO2<93%], gait speed, FEV1/FVC ratio, and inspiratory muscle strength [MIP % predicted])
O
Outcome
Postoperative pulmonary complications (PPCs)hard clinical

Main Result

Absolute Event Rate: 14.2% vs 85.8%

p-value: p=0.412

A parsimonious prediction model using five modifiable physiological variables accurately predicts postoperative pulmonary complications in cardiac surgery patients, providing a tool to guide individualized prehabilitation.

Limitations

  • No information on study design and methodology.
  • Lack of demographic and baseline characteristics details.
  • No statistical results beyond chi-square p-value for procedure categories.
  • Unclear if multicenter or single-center study.
  • No effect size metrics reported for primary outcome.

Cite This Study

Li et al. (2026) studied Patients undergoing cardiac surgery with risk of postoperative pulmonary complications (n=492). Postoperative pulmonary complications occurred in 14.2% of cardiac surgery patients with no significant difference in surgical procedure categories (p=0.412).

synapsesocial.com/papers/69a286b80a974eb0d3c01d3ahttps://doi.org/10.5535/arm.250092
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prediction of Postoperative Pulmonary Complications on the Basis of Preoperative Risk Factors in Patients Who Had Undergone Coronary Artery Bypass Graft Surgery2003 · 138 citations
  2. 2Risk Stratification for Postoperative Pulmonary Complications following Major Cardiothoracic and Abdominal Surgery – development of the PPC Risk Prediction Score for Physiotherapists Clinical Decision-making2022 · 5 citations
  3. 3Multivariate Analysis of Factors Associated With Postoperative Pulmonary Complications Following General Elective Surgery1998 · 176 citations
  4. 4Development of a Prediction Rule for Estimating Postoperative Pulmonary Complications2014 · 69 citations
  5. 5Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery2021 · 2 citations