Modifiable surgical and anesthesiologic risk factors for the development of cardiac and pulmonary complications after laparoscopic colorectal surgery.
BACKGROUND
In contrast to patient-related risk factors, which are difficult to influence, factors relating to surgery and anesthesia that can be influenced have hardly been investigated. This study aimed to identify such risk factors.


METHODS
Pre- and intraoperative surgical and anesthesiologic factors of 388 colonic and 112 rectal procedures performed by a single surgeon within 50 months were recorded and analyzed for correlations with postoperative complications requiring treatment.


RESULTS
Higher American Society of Anesthesiology (ASA) emergency interventions and intraoperative factors (bleeding, long operating time) had an elevated risk for general complications. Furthermore, patients benefited from the clinical experience of the anesthesiologist, especially in terms of emergency procedures, hemorrhagic complications, and a longer operating time.


CONCLUSIONS
Standardization of the surgical technique, "bloodless" surgery, standardization of intraoperative monitoring, and the use of board-certified anesthesiologists for high-risk cases, emergency procedures, and patients with high ASA stages are able to reduce postoperative morbidity.
Böttger
Th C
TC
Klinik für Viszeral-, Thorax- und Gefässchirurgie, Zentrum für minimalinvasive Chirurgie, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany.
Hermeneit
S
S
Müller
M
M
Terzic
A
A
Rodehorst
A
A
Elad
L
L
Schamberger
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods*; D000776:Anesthesiology / Q000592:standards; D002983:Clinical Competence; D003108:Colonic Diseases / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000592:standards; D010535:Laparoscopy / Q000379:methods*; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012307:Risk Factors; D012308:Risk Management; D012720:Severity of Illness Index; D013044:Specialty Boards; D055815:Young Adult