title: Pulmonary Complications After Open Abdominal Aortic Surgery: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Postoperative pulmonary complications (PPC) are among the most common complications after noncardiac surgery. Men, smokers, and elderly patients with chronic obstructive pulmonary disease or heart failure are more likely to experience PPC. The majority of patients undergoing vascular surgery belong in these categories and are at higher risk of developing PPC. Moreover, the surgical site is one of the most important risk factors associated with PPC, and aortic surgery carries the highest risk. The aim of this systematic review was to obtain an additional understanding of the real incidence of PPC after open abdominal aortic surgery and the impact of PPC on survival.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Hospitals PARTICIPANTS: Patients who underwent open abdominal aortic surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  A literature search was performed on BioMedCentral, PubMed, Embase, and the Cochrane Register of clinical trials. All prospective or retrospective studies reporting data on PPC after open abdominal aortic surgery were included. Co-primary endpoints were the PPC rate and the correlation between PPC and perioperative mortality. The secondary endpoint was the difference in the PPC rate and mortality between elective and urgent surgery. Data on 269,637 patients from 213 studies were analyzed. The overall median incidence of PPC was 10.3% (interquartile range 5.55%-19.1%). Pneumonia, respiratory insufficiency, prolonged mechanical ventilation, need for unplanned mechanical ventilation, atelectasis, acute respiratory distress syndrome, pulmonary edema, and pleural effusions were the most common PPC reported in the literature. Occurrence of PPC was associated with postoperative mortality (r = 0.65, p<0.01) and was significantly higher in urgent procedures (p<0.001).
  
  
  CONCLUSIONS
  Incidence of PPC after open abdominal aortic surgery is high and is associated with increased postoperative morbidity and mortality.
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy. Electronic address: laurapasin1704@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Nardelli
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Belletti
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.affiliation: Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D012120:Respiration Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies
keywords: abdominal; aortic aneurysm; postoperative complications; postoperative pulmonary atelectasis