[Influenceable surgical and anesthesiological risk factors for the development of cardiac and pulmonary complications in laparoscopic surgery of the colon].
BACKGROUND
Due to the demographic shift in the age structure of the population, increasingly older, multimorbid patients are operated who have a substantially higher risk for the occurrence of intra- and postoperative complications. Apart from the identification of patient-referred, hardly influenceable risk factors, influenceable intraoperative surgical and anesthesiological risk factors have hardly ever been examined. The aim of this investigation was therefore to identify influenceable risk factors for the development of post-operative morbidity.


METHODS
In a period of 44 months, we performed a laparoscopic colon resection in 157 men and 209 women with a mean age of 63 years. The ASA classification, POSSUM score, status of the anesthesiologist, change of the anesthesiologist, intraoperative monitoring, kind of anaesthesia, fluctuations of blood pressure and pulse during the operation, shock-index > 1, substitution of erythrocyte concentrates and FFPs as well as intraoperative surgical complications were documented prospectively. Postoperative general complications requiring therapy, in particular, cardiac and pulmonal problems as well as surgical complications, in particular, infections and hemorrhages, were documented. The data analysis was performed using the program package SPSS.


RESULTS
Intraoperative monitoring was more frequently used in higher ASA stages, whereas for ASA stage IV no central venous line was used in 17 % and no arterial catheter was placed in 33 %. a similar tendency concerning the POSSUM score could not be determined. Patients cared for by junior surgeons exhibited cardiac complications in 6.7 % and 13.1 % had to be mechanically ventilated postoperatively versus 2 % of cardiac complications and 9 % mechanical ventilation among those managed by specialists. An increase in postoperative complications could also be found when a change in anesthesia took place. During treatment by an assistant in case of emergencies, in cases where intraoperative substitution of erythrocytes or an operation lasting more than two hours, more cardiac complications and a higher rate of mechanical respiration was observed than during treatment by a specialist. A mechanical respiration was significantly more necessary in higher ASA stages (p < 0.01), in an operation lasting more than 2 hours (p < 0.01), in cases with the occurrence of intraoperative bleeding complications (p < 0.01), procedures with a lower status of the anesthesiologist (p < 0.01) and in procedures with a change of the anesthesiologist (p < 0.05).


CONCLUSIONS
Factors such as overweight, ASA classification or urgency cannot be changed. Surgical factors such as a standardisation of the operation technique with reduction of the operating time and careful staunching of bleeding can help to reduce postoperative complications. Anesthesiologists can also help by avoiding a change of the anesthesiologist as well as by preference of specialists in patients with higher ASA stages and in emergency cases.
Hermeneit
S
S
Klinik für Viszeral-, Thorax- und Gefässchirurgie, Zentrum für minimalinvasive Chirurgie.
Müller
M
M
Terzic
A
A
Rodehorst
A
A
Schamberger
M
M
Böttger
T
T
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D003106:Colon / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D006304:Health Status; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D050177:Overweight; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors