Predicting severe postoperative respiratory complications following abdominal wall reconstruction.
BACKGROUND
Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction.


METHODS
All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care.


RESULTS
Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH(2)O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH(2)O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH(2)O, the odds ratio was 11.5.


CONCLUSIONS
Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH(2)O are at an increased risk of severe postoperative respiratory complications.
Cleveland, Ohio From the Departments of Surgery and Anesthesiology, University Hospitals Case Medical Center.
Jeffrey A
JA
Blatnik
David M
DM
Krpata
Nicholas L
NL
Pesa
Peter
P
Will
Karem C
KC
Harth
Yuri W
YW
Novitsky
James R
JR
Rowbottom
Michael J
MJ
Rosen
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh