Respiratory Complications After Colorectal Surgery: Avoidable or Fate?

• Published in: World journal of surgery Vol. 42; no. 9; pp. 2708 - 2714
• Main Authors: Jurt, Jonas, Hübner, Martin, Pache, Basile, Hahnloser, Dieter, Demartines, Nicolas, Grass, Fabian
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Complications; Confidence intervals; Demographics; General Surgery; Laparoscopy; Medicine; Medicine & Public Health; Original Scientific Report; Patients; Prevention; Regression analysis; Risk analysis; Risk factors; Surgery; Thoracic Surgery; Tubes; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4699-2

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.