Respiratory Complications After Colorectal Surgery: Avoidable or Fate?

World J Surg. 2018 Sep;42(9):2708-2714. doi: 10.1007/s00268-018-4699-2.

Abstract

Background: The prevention of post-operative pulmonary complications (PPC) is targeted by several enhanced recovery (ERAS) items including early mobilisation, prevention of fluid overload and omission of routine nasogastric tubes. The aim of the present study was to assess the impact of ERAS on PPC.

Methods: This was a retrospective analysis of an institutional database including consecutive colorectal ERAS procedures from May 2011 until May 2017. Multiple logistic regressions were performed to identify risk factors for PPC among demographic, surgical characteristics and items related to the ERAS protocol.

Results: In total, 1298 patients were included; among them 120 (9.2%) had one or more PPC. Multivariable analysis retained minimally invasive surgery [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.15-0.46] and compliance to the ERAS protocol of ≥ 70% (OR 0.53; CI 0.30-0.94) as protective factors. Emergency surgery (OR 2.70; CI 1.20-6.01), blood loss of ≥ 200 mL (OR 2.06; CI 1.20-3.53) and ASA score of ≥ 3 (OR 2.00; CI 1.12-3.57) were independent risk factors. Median length of hospital stay was significantly longer in patients who experienced respiratory complications (21 [4-183] vs. 6 [1-95] days, p ≤ 0.001).

Conclusions: Minimally invasive surgery and high compliance with the ERAS protocol can help to prevent PPC.

MeSH terms

  • Aged
  • Clinical Protocols*
  • Colectomy / adverse effects*
  • Early Ambulation
  • Female
  • Fluid Therapy / adverse effects
  • Guideline Adherence
  • Humans
  • Intubation, Gastrointestinal / adverse effects
  • Length of Stay
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Patient Compliance
  • Perioperative Care
  • Proctectomy / adverse effects*
  • Recovery of Function
  • Respiration Disorders / etiology
  • Respiration Disorders / prevention & control*
  • Retrospective Studies
  • Risk Factors