54.14 Risk Factors for Postoperative Respiratory Failure in Abdominal Surgery

Posted on September 9, 2020

D. Orabi1, R. Naples1, D. Brundidge2, K. Snyder1, D. Agarwal2, M. Gohar2, S. Govindarajan2, M. Argalious2, P. Mathur2, S. Asfaw1  1Cleveland Clinic,Department Of General Surgery,Cleveland, OH, USA 2Cleveland Clinic,Department Of Anesthesiology,Cleveland, OH, USA

Introduction:
Postoperative respiratory failure (PRF) contributes to significant morbidity and mortality in surgical patients. Prior PRF studies include a potpourri of patients. We sought to identify patient characteristics and perioperative risk factors associated with PRF in general surgery patients undergoing abdominal surgery, in an effort to improve patient outcomes.

Methods:
We retrospectively reviewed patients undergoing elective abdominal surgery from 2011-2016 at our institution. Our experimental cohort consisted of all adult patients with the International Classification of Diseases (ICD) diagnosis of acute respiratory failure, and we compared this to a time-matched control cohort.

Results:
238 patients were in the experimental cohort and were compared to 238 control patients. On univariate analysis comorbidities associated with respiratory failure included coronary artery disease, hypertension, chronic obstructive pulmonary disease (COPD), type 2 diabetes, chronic kidney disease, and hypoalbuminemia (p<0.05). Also American Society of Anaesthesiologists’ score IV (19.7% vs 3.9%, p<0.001), operative time (352 vs 225 minutes, p<0.001), intraoperative blood products (32.8% vs 6.0%, p<0.001), estimated blood loss (338 vs 100 mL, p=0.008), net intraoperative fluid balance (3635 vs 2430 mL, p<0.001), and epidural use (24.4% vs 12.7%, p=0.002) were higher in patients with PRF. Additionally, PRF patients had increased rates of surgical complications (47.9% vs 14.7%, p<0.001), reoperation (46.4% vs 3.4%, p<0.001), inpatient mortality (19.3% vs 0%, p<0.001) and length of stay (22.7 days vs 6.3 days, p<0.001). Using multivariate logistic regression, age, COPD, operative time, and reoperation maintained significance (p<0.05).

Conclusion:
PRF leads to increased morbidity, mortality, and hospital length of stay. We have identified contributing pre- and perioperative risk factors. Development of a perioperative scoring system specific to general surgery patients undergoing abdominal surgery will help identify those at increased risk for respiratory failure and mitigate complications with directed management.