Respiratory Complications After Colorectal Surgery: Avoidable or Fate?

• DOI: 10.1007/s00268-018-4699-2
• Publication Date: 2018-06-20T16:35:07Z
• Authors: Jonas Jurt; Martin Hübner; Basile Pache; Dieter Hahnloser; Nicolas Demartines; Fabian Grass
• Keywords: Male; Proctectomy; Recovery of Function; Length of Stay; Middle Aged; Respiration Disorders; Perioperative Care; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Clinical Protocols; Risk Factors; Fluid Therapy; Humans; Minimally Invasive Surgical Procedures; Patient Compliance; Female; Guideline Adherence; Intubation, Gastrointestinal; Colectomy; Early Ambulation; Aged; Retrospective Studies

AbstractBackgroundThe 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.MethodsThis 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.ResultsIn 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).ConclusionsMinimally invasive surgery and high compliance with the ERAS protocol can help to prevent PPC.