ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2017 September;24(3):77-82

DOI: 10.23736/S1824-4777.17.01302-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Predictors of pulmonary complications after open thoracoabdominal aortic aneurysm repair

Laura PASIN ¹ ✉, Pasquale NARDELLI ², Luca CABRINI ², Massimiliano NUZZI ², Efrem CIVILINI ³, Luca BERTOGLIO ⁴, Roberto CHIESA ^{4, 5}, Giovanni LANDONI ^{2, 5}

¹ Department of Anesthesia and Intensive Care, S. Antonio Hospital, Padua, Italy; ² Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; ³ Department of Vascular Surgery I, Humanitas Research Hospital, Rozzano, Italy; ⁴ Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁵ Vita-Salute San Raffaele University, Milan, Italy

BACKGROUND: Open thoracoabdominal aortic aneurysm (TAAA) repair still carries a significant risk of perioperative morbidity and mortality. Among the several postoperative complications reported in literature, postoperative pulmonary complications (PPCs) are the most frequent ones. Since PPCs are strongly associated with unfavorable outcome after major non-cardiac surgery and increase postoperative length of hospital stay and costs, we decided to examine the incidence of PPCs of patients who underwent open TAAA repair in our center and we tried to assess the predictive factors of PPCs.
METHODS: Data of all patients who underwent TAAA repair between January 2009 and March 2015 in our center were recorded. Primary endpoint was to identify the incidence of (PPCs). Independent predictors of PPCs were identified.
RESULTS: A total of 372 patients underwent open TAAA repair during the study period and were included in the analysis. Two-hundred and seven patients (55.6%) developed PPCs. The most frequently observed PPC was mild hypoxia/hypercapnia requiring non-invasive ventilation in the main ward (85% of patients who developed PPCs). Few patients developed severe complications such as pneumonia (2.7%), need for tracheal reintubation (5.1%) and respiratory failure requiring mechanical ventilation for more than 48 hours (9.9%). A multivariate analysis identified as independent predictors of PPCs Crawford’s aneurysm type IV, blood losses, savaged blood reinfusion and positive fluid balance. The occurrence of PPCs prolonged both ICU stay and hospital stay while no differences in mortality were observed.
CONCLUSIONS: Despite great advances in surgical and anesthesiological techniques, PPCs after TAAA repair remain extremely high. In our experience early application of postoperative non-invasive ventilation for hypoxia helped to have a relatively low number of severe pulmonary complications.

KEY WORDS: Aortic aneurysm, thoracic - Postoperative complications - Noninvasive ventilation