Postoperative pulmonary complications after laparotomy.

BACKGROUND The frequency of, and risks for, postoperative pulmonary complications (PPCs) after laparotomy are incompletely understood. The wide-ranging incidence of PPCs in the literature reflects methodological issues including variable definitions of PPCs and varied patient populations. OBJECTIVES We sought to elucidate the incidence of PPCs after laparotomy and clarify risks for their development. METHODS We conducted a retrospective study of all laparotomies in adult patients on the general surgery service at our university-affiliated hospital in 2004. The definition of PPCs was rigorous and relevant in terms of key outcomes (morbidity, mortality, length of stay). We used a template for the review of medical records to identify PPCs and their consequences. RESULTS Twenty-five PPCs (7.0%) occurred in 359 laparotomies. Logistic regression modeling identified the following independent predictors of risk: upper abdominal incisions (OR 15.3; p = 0.025), reoperation (OR 7.1; p = 0.013), emergency surgery (OR 6.3; p = 0.001) and nasogastric tubes (OR 5.4; p = 0.008). PPCs were associated with increased mortality (OR 6.17; p = 0.01), intensive care unit care (OR 13.0; p = 0.001), increased mean hospital length of stay (17.7 days longer; p = 0.001) and longer mean postoperative length of stay (15.2 days longer; p = 0.001). CONCLUSIONS The incidence of PPCs after laparotomy in this study is lower than in many prior reports and reflects the relevant definition of PPCs used. Upper abdominal surgery carried the greatest risk. Reoperation was a risk not identified previously. Emergency procedures and the use of nasogastric tubes were confirmed as key risks. Morbidity, mortality and lengths of stay were significantly increased after PPCs.