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Research ArticleOriginal Research

Perioperative Factors Associated With Respiratory Complications Following Open Abdomen Management

Koichi Inukai, Akihiro Usui, Koji Amano, Hiroyuki Kayata, Nobutaka Mukai, Yusuke Tsunetoshi and Yasuki Nakata
Respiratory Care November 2020, 65 (11) 1663-1667; DOI: https://doi.org/10.4187/respcare.07657
Koichi Inukai
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Akihiro Usui
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Koji Amano
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Hiroyuki Kayata
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Nobutaka Mukai
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Yusuke Tsunetoshi
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Yasuki Nakata
Department of Acute Care Surgery, Sakai City Medical Center, Osaka, Japan.
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Abstract

BACKGROUND: Postoperative respiratory complications are often severe and associated with a high risk of mortality in patients who undergo open abdomen (OA) management following emergency damage-control surgery. The causes of postoperative respiratory complications remain unknown. Therefore, we evaluated postoperative factors associated with respiratory complications in nontrauma patients who had undergone OA management using propensity score matching, with a focus on OA-related risk factors.

METHODS: This retrospective analysis included subjects who underwent OA management during a 4-y study period. Age, body mass index, and smoking history were selected as covariates. After propensity score matching, we compared postoperative factors (ie, first operative time, duration of OA, initial 3-d fluid balance, length of ICU stay, and in-hospital mortality) in 2 groups of subjects: those who had post-OA respiratory complications (PORCs) and those who did not.

RESULTS: 60 subjects (33 men and 27 women) were identified; 38.3% of these subjects had PORCs. After propensity score matching, 18 subjects were matched. The 3-d fluid balance was significantly higher in subjects with PORCs than in those without PORCs (3,513 mL vs 1,087 mL; P = .03).

CONCLUSIONS: To our knowledge, this is the first study to examine factors associated with respiratory complications following OA in nontrauma subjects. After adjusting for known co-factors associated with postoperative respiratory complications, the 3-d fluid balance was identified as a significant risk factor for PORCs in subjects who had undergone OA. Clinicians should pay attention to the incidence of PORCs in OA subjects with a positive fluid balance after emergency abdominal surgery.

  • open abdomen
  • open abdominal management
  • postoperative open-abdomen respiratory complication
  • emergency surgery
  • respiratory failure
  • fluid balance

Footnotes

  • Correspondence: Koichi Inukai MD, Department of Acute Care Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku Sakai, Osaka 593-8322 Japan. E-mail: koichi.sums{at}gmail.com
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (11)
Respiratory Care
Vol. 65, Issue 11
1 Nov 2020
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Perioperative Factors Associated With Respiratory Complications Following Open Abdomen Management
Koichi Inukai, Akihiro Usui, Koji Amano, Hiroyuki Kayata, Nobutaka Mukai, Yusuke Tsunetoshi, Yasuki Nakata
Respiratory Care Nov 2020, 65 (11) 1663-1667; DOI: 10.4187/respcare.07657

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Perioperative Factors Associated With Respiratory Complications Following Open Abdomen Management
Koichi Inukai, Akihiro Usui, Koji Amano, Hiroyuki Kayata, Nobutaka Mukai, Yusuke Tsunetoshi, Yasuki Nakata
Respiratory Care Nov 2020, 65 (11) 1663-1667; DOI: 10.4187/respcare.07657
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Keywords

  • open abdomen
  • open abdominal management
  • postoperative open-abdomen respiratory complication
  • emergency surgery
  • respiratory failure
  • fluid balance

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