Top

World Journal of Surgery

Published in:

01-09-2018 | Original Scientific Report

Respiratory Complications After Colorectal Surgery: Avoidable or Fate?

Authors: Jonas Jurt, Martin Hübner, Basile Pache, Dieter Hahnloser, Nicolas Demartines, Fabian Grass

Published in: World Journal of Surgery | Issue 9/2018

Abstract

Background

The prevention of post-operative pulmonary complications (PPC) is targeted by several enhanced recovery (ERAS) items including early mobilisation, prevention of fluid overload and omission of routine nasogastric tubes. The aim of the present study was to assess the impact of ERAS on PPC.

Methods

This was a retrospective analysis of an institutional database including consecutive colorectal ERAS procedures from May 2011 until May 2017. Multiple logistic regressions were performed to identify risk factors for PPC among demographic, surgical characteristics and items related to the ERAS protocol.

Results

In total, 1298 patients were included; among them 120 (9.2%) had one or more PPC. Multivariable analysis retained minimally invasive surgery [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.15–0.46] and compliance to the ERAS protocol of ≥ 70% (OR 0.53; CI 0.30–0.94) as protective factors. Emergency surgery (OR 2.70; CI 1.20–6.01), blood loss of ≥ 200 mL (OR 2.06; CI 1.20–3.53) and ASA score of ≥ 3 (OR 2.00; CI 1.12–3.57) were independent risk factors. Median length of hospital stay was significantly longer in patients who experienced respiratory complications (21 [4–183] vs. 6 [1–95] days, p ≤ 0.001).

Conclusions

Minimally invasive surgery and high compliance with the ERAS protocol can help to prevent PPC.

Smith PR, Baig MA, Brito V, Bader F, Bergman MI, Alfonso A (2010) Postoperative pulmonary complications after laparotomy. Respiration 80(4):269–274CrossRefPubMed

Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242(3):326–341 (discussion 41-3) PubMedPubMedCentral

Haines KJ, Skinner EH, Berney S, Austin Health PSI (2013) Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy 99(2):119–125CrossRefPubMed

Zogg CK, Najjar P, Diaz AJ, Zogg DL, Tsai TC, Rose JA Jr et al (2016) Rethinking priorities: cost of complications after elective colectomy. Ann Surg 264(2):312–322CrossRefPubMed

Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38(6):1531–1541. https://doi.org/10.1007/s00268-013-2416-8 CrossRefPubMed

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N et al (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37(2):259–284. https://doi.org/10.1007/s00268-012-1772-0 CrossRefPubMed

Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hubner M et al (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100(8):1108–1114CrossRefPubMed

Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN et al (2013) Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37(2):285–305. https://doi.org/10.1007/s00268-012-1787-6 CrossRefPubMed

Roulin D, Blanc C, Muradbegovic M, Hahnloser D, Demartines N, Hubner M (2014) Enhanced recovery pathway for urgent colectomy. World J Surg 38(8):2153–2159. https://doi.org/10.1007/s00268-014-2518-y CrossRefPubMed

10.

Grass F, Slieker J, Jurt J, Kummer A, Sola J, Hahnloser D et al (2017) Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study. Int J Colorectal Dis 32(5):675–681CrossRefPubMed

11.

Miskovic A, Lumb AB (2017) Postoperative pulmonary complications. Br J Anaesth 118(3):317–334CrossRefPubMed

12.

Jurt J, Slieker J, Frauche P, Addor V, Sola J, Demartines N et al (2017) Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg 41:2464–2470. https://doi.org/10.1007/s00268-017-4054-z CrossRefPubMed

13.

Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J et al (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146(5):571–577CrossRefPubMed

14.

Smit LC, Bruins MJ, Patijn GA, Ruijs GJ (2016) Infectious complications after major abdominal cancer surgery: in search of improvable risk factors. Surg Infect Larchmt 17(6):683–693CrossRefPubMed

15.

Group EC (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261(6):1153–1159CrossRef

16.

Canet J, Sabate S, Mazo V, Gallart L, de Abreu MG, Belda J et al (2015) Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol 32(7):458–470CrossRefPubMed

17.

Fleisher LA, Linde-Zwirble WT (2014) Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures. Perioper Med (Lond) 3:7CrossRef

18.

Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL et al (2013) Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology 118(6):1276–1285CrossRefPubMed

19.

Lumb AB, McLure HA (2016) AAGBI recommendations for standards of monitoring during anaesthesia and recovery 2015—a further example of ‘aggregation of marginal gains’. Anaesthesia 71(1):3–6CrossRefPubMed

20.

Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS et al (2016) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60(3):289–334CrossRefPubMed

21.

Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ et al (2015) Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59(10):1212–1231CrossRefPubMedPubMedCentral

22.

Stolbrink M, McGowan L, Saman H, Nguyen T, Knightly R, Sharpe J et al (2014) The Early Mobility Bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. J Hosp Infect 88(1):34–39CrossRefPubMed

23.

Pache B, Hubner M, Jurt J, Demartines N, Grass F (2017) Minimally invasive surgery and enhanced recovery after surgery: the ideal combination? J Surg Oncol 116(5):613–616CrossRefPubMed

24.

Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29(12):3443–3453CrossRefPubMedPubMedCentral

25.

Powell R, Scott NW, Manyande A, Bruce J, Vogele C, Byrne-Davis LM et al (2016) Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 25(5):CD008646

26.

Forsmo HM, Pfeffer F, Rasdal A, Ostgaard G, Mohn AC, Korner H et al (2016) Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial. Colorectal Dis 18(6):603–611CrossRefPubMed

27.

Hubner M, Blanc C, Roulin D, Winiker M, Gander S, Demartines N (2015) Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg 261(4):648–653CrossRefPubMed

28.

Myles PS, Andrews S, Nicholson J, Lobo DN, Mythen M (2017) Contemporary approaches to perioperative IV fluid therapy. World J Surg 41:2457–2463. https://doi.org/10.1007/s00268-017-4055-y CrossRefPubMed

29.

Gupta R, Gan TJ (2016) Peri-operative fluid management to enhance recovery. Anaesthesia 71(Suppl 1):40–45CrossRefPubMed

30.

Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238(5):641–648CrossRefPubMedPubMedCentral

31.

Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N, Zurich Fast Track Study G (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136(3):842–847CrossRefPubMed

32.

Merki-Kunzli C, Kerstan-Huber M, Switalla D, Gisi D, Raptis DA, Greco N et al (2017) Assessing the value of prehabilitation in patients undergoing colorectal surgery according to the enhanced recovery after surgery (ERAS) pathway for the improvement of postoperative outcomes: protocol for a randomized controlled trial. JMIR Res Protoc 6(10):e199CrossRefPubMedPubMedCentral

33.

Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F (2017) Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol 56(2):295–300CrossRefPubMed

34.

Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD et al (2017) Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 32:1280–1285CrossRefPubMed

35.

Slieker J, Frauche P, Jurt J, Addor V, Blanc C, Demartines N et al (2017) Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis 32(2):215–221CrossRefPubMed

36.

Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A (2014) A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis 16(12):947–956CrossRefPubMed

Title: Respiratory Complications After Colorectal Surgery: Avoidable or Fate?
Authors: Jonas Jurt
Martin Hübner
Basile Pache
Dieter Hahnloser
Nicolas Demartines
Fabian Grass
Publication date: 01-09-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4699-2

At a glance: The STEP trials

Springer Medicine

Respiratory Complications After Colorectal Surgery: Avoidable or Fate?

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2018

A Novel Indocyanine Green Fluorescence-Guided Video-Assisted Technique for Sentinel Node Biopsy in Breast Cancer

Awake Tracheostomy: Indications, Complications and Outcome

Preoperative Smoking Cessation is Integral to the Prevention of Postoperative Morbidities in Minimally Invasive Esophagectomy

Parastomal Hernia Repair with a 3D Funnel Intraperitoneal Mesh Device and Same-Sided Stoma Relocation: Results of 56 Cases

The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada

Surgical Management of Ranula Revisited