World journal of surgery · 2018
Respiratory Complications After Colorectal Surgery: Avoidable or Fate?
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Jurt Jonas, Hübner Martin, Pache Basile, Hahnloser Dieter, Demartines Nicolas, Grass Fabian
Аннотация
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.
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.
Предметные рубрики MeSH
AgedClinical ProtocolsColectomyEarly AmbulationFemaleFluid TherapyGuideline AdherenceHumansIntubation, GastrointestinalLength of StayMaleMiddle AgedMinimally Invasive Surgical ProceduresPatient CompliancePerioperative CareProctectomyRecovery of FunctionRespiration DisordersRetrospective StudiesRisk Factors