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Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit?
Surg Endosc 2018; 32(3):1280-1285SE

Abstract

BACKGROUND

Patients with severe chronic obstructive pulmonary disease (COPD) are at a higher risk for postoperative respiratory complications. Despite the benefits of a minimally invasive approach, laparoscopic pneumoperitoneum can substantially reduce functional residual capacity and raise alveolar dead space, potentially increasing the risk of respiratory failure which may be poorly tolerated by COPD patients. This raises controversy as to whether open techniques should be preferentially employed in this population.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2014 was used to examine the clinical data from patients with COPD who electively underwent laparoscopic and open colectomy. Patients defined as having COPD demonstrated either functional disability, chronic use of bronchodilators, prior COPD-related hospitalization, or reduced forced expiratory reserve volumes on lung testing (FEV1 <75%). Demographic data and preoperative characteristics were compared. Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes.

RESULTS

Of the 4397 patients with COPD, 53.8% underwent laparoscopic colectomy (LC) while 46.2% underwent open colectomy (OC). The LC and OC groups were similar with respect to demographic data and preoperative comorbidities. Equivalent frequencies of exertional dyspnea (LC 35.4 vs OC 37.7%, P = 0.11) were noted. After multivariate risk adjustment, OC demonstrated an increased rate of overall respiratory complications including pneumonia, reintubation, and prolonged ventilator dependency when compared to LC (OR 1.60, 95% CI 1.30-1.98, P < 0.01). OC was associated with longer length of stay (10 ± 8 vs. 6.7 ± 7 days, P < 0.01) and higher readmission (OR 1.36, 95% CI 1.09-1.68, P < 0.01) compared to LC.

CONCLUSION

Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in postoperative morbidity.

Authors+Show Affiliations

Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA. apigazzi@uci.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28812150

Citation

Sujatha-Bhaskar, Sarath, et al. "Respiratory Complications After Colonic Procedures in Chronic Obstructive Pulmonary Disease: Does Laparoscopy Offer a Benefit?" Surgical Endoscopy, vol. 32, no. 3, 2018, pp. 1280-1285.
Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, et al. Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc. 2018;32(3):1280-1285.
Sujatha-Bhaskar, S., Alizadeh, R. F., Inaba, C. S., Koh, C. Y., Jafari, M. D., Mills, S. D., ... Pigazzi, A. (2018). Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surgical Endoscopy, 32(3), pp. 1280-1285. doi:10.1007/s00464-017-5805-5.
Sujatha-Bhaskar S, et al. Respiratory Complications After Colonic Procedures in Chronic Obstructive Pulmonary Disease: Does Laparoscopy Offer a Benefit. Surg Endosc. 2018;32(3):1280-1285. PubMed PMID: 28812150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? AU - Sujatha-Bhaskar,Sarath, AU - Alizadeh,Reza Fazl, AU - Inaba,Colette S, AU - Koh,Christina Y, AU - Jafari,Mehraneh D, AU - Mills,Steven D, AU - Carmichael,Joseph C, AU - Stamos,Michael J, AU - Pigazzi,Alessio, Y1 - 2017/08/15/ PY - 2017/04/10/received PY - 2017/07/29/accepted PY - 2017/8/16/pubmed PY - 2019/8/3/medline PY - 2017/8/17/entrez KW - COPD KW - Colectomy KW - Colorectal disease KW - Laparoscopy SP - 1280 EP - 1285 JF - Surgical endoscopy JO - Surg Endosc VL - 32 IS - 3 N2 - BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) are at a higher risk for postoperative respiratory complications. Despite the benefits of a minimally invasive approach, laparoscopic pneumoperitoneum can substantially reduce functional residual capacity and raise alveolar dead space, potentially increasing the risk of respiratory failure which may be poorly tolerated by COPD patients. This raises controversy as to whether open techniques should be preferentially employed in this population. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2014 was used to examine the clinical data from patients with COPD who electively underwent laparoscopic and open colectomy. Patients defined as having COPD demonstrated either functional disability, chronic use of bronchodilators, prior COPD-related hospitalization, or reduced forced expiratory reserve volumes on lung testing (FEV1 <75%). Demographic data and preoperative characteristics were compared. Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes. RESULTS: Of the 4397 patients with COPD, 53.8% underwent laparoscopic colectomy (LC) while 46.2% underwent open colectomy (OC). The LC and OC groups were similar with respect to demographic data and preoperative comorbidities. Equivalent frequencies of exertional dyspnea (LC 35.4 vs OC 37.7%, P = 0.11) were noted. After multivariate risk adjustment, OC demonstrated an increased rate of overall respiratory complications including pneumonia, reintubation, and prolonged ventilator dependency when compared to LC (OR 1.60, 95% CI 1.30-1.98, P < 0.01). OC was associated with longer length of stay (10 ± 8 vs. 6.7 ± 7 days, P < 0.01) and higher readmission (OR 1.36, 95% CI 1.09-1.68, P < 0.01) compared to LC. CONCLUSION: Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in postoperative morbidity. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/28812150/Respiratory_complications_after_colonic_procedures_in_chronic_obstructive_pulmonary_disease:_does_laparoscopy_offer_a_benefit L2 - https://dx.doi.org/10.1007/s00464-017-5805-5 DB - PRIME DP - Unbound Medicine ER -