Abstract
Background
Patients undergoing abdominal wall reconstruction (AWR) are at an increased risk of developing respiratory complications. Previous studies have demonstrated that postoperative findings, such as an increase in plateau pressure greater than 6 cm H2O following fascial closure, creates an increased risk of postoperative respiratory complications. The purpose of this study is to determine if specific preoperative characteristics are an indicator for postoperative respiratory failure.
Methods
The 2005–2013 ACS-NSQIP participant use data were reviewed to evaluate post-operative intubation status following AWR procedures for ventral hernias. Prolonged intubation, defined as intubation up to 48 h post-operatively, was evaluated. Multivariable logistic regression was used to control for patient demographics and comorbidities. Odds ratios and 95% confidence intervals were reported as appropriate using SPSS.
Results
4378 patients were identified. Majority (51%) of patients were female. 2.96% of patients experienced a prolonged intubation. Factors such as a history of severe COPD, ASA 3 or 4, current smoker within 1 year, and a BMI of 40 were all found to have a significant association with a prolonged intubation.
Conclusions
Post-operative prolonged intubation is a known complication of AWR. We have demonstrated that pre-operative factors, such as a history of COPD, ASA 3 or 4, current smoker, and a BMI > 40 kg/m2 are factors associated with a prolonged intubation. Optimization of each may allow for a reduction in the risk of prolonged intubation in patients undergoing AWR.
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Dr. Salvatore Docimo reports personal fees from Boston Scientific, from null, during the conduct of the study; Dr. Aurora Pryor reports personal fees from Ethicon, personal fees from Medtronic, personal fees from Stryker, from Gore, grants from Baranova, grants from Obalon, outside the submitted work. Dr. Konstantinos Spaniolas, Dr. Maria Altieri, Dr. Andrew Bates, and Dr. Mark Talamini have no conflicts of interest or financial ties to disclose.
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Docimo, S., Spaniolas, K., Altieri, M. et al. Pre-operative characteristics and their role in prolonged intubation following abdominal wall reconstruction. Surg Endosc 33, 2345–2348 (2019). https://doi.org/10.1007/s00464-018-6536-y
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DOI: https://doi.org/10.1007/s00464-018-6536-y