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Analysis of Risk Factors, Morbidity, and Cost Associated with Respiratory Complications following Abdominal Wall Reconstruction

Fischer, John P. M.D.; Wes, Ari M. B.A.; Wink, Jason D. B.A.; Nelson, Jonas A. M.D.; Braslow, Benjamin M. M.D.; Kovach, Stephen J. M.D.

Plastic & Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 147–156
doi: 10.1097/01.prs.0000436836.96194.a2
Reconstructive: Trunk: Original Articles

Background: Ventral hernia remains a continued and expensive problem for general and reconstructive surgeons, alike. The aim of this study was to assess perioperative factors and cost associated with postoperative respiratory morbidity in abdominal wall reconstruction.

Methods: A retrospective review of abdominal wall reconstruction patients operated on between 2007 and 2012 was performed. Analysis of perioperative factors associated with postoperative respiratory morbidity was performed using hospital-defined International Classification of Diseases, Ninth Revision codes. Bivariate and multivariate logistic regression analyses were used to assess independent predictors of postoperative respiratory morbidity, and linear regression was used to determine the financial impact.

Results: One hundred thirty-four consecutive abdominal wall reconstructions performed by a single surgeon over a 5-year period were included. Respiratory complications occurred in 15.7 percent of patients (n = 21); 5.2 percent required reintubation (n = 7) and 5.2 percent failed to wean from ventilatory support postoperatively (n = 7). Patients experiencing respiratory morbidity stayed on average 16.2 days longer (p < 0.0001) and represented the only three patients in the study experiencing mortality (p = 0.003). Regression analysis demonstrated that intraoperative blood transfusions (p = 0.008), highest peak intraoperative airway pressure (p = 0.017), fascial closure (p = 0.013), and American Society of Anesthesiologists physical status (p = 0.019) were all associated with postoperative respiratory morbidity. Linear regression analysis demonstrated that respiratory complications added a cost of $60,933 per patient (p < 0.001).

Conclusions: Postoperative respiratory morbidity following abdominal wall reconstruction is a common occurrence linked to identifiable perioperative risk factors and associated with significant mortality and a tremendous cost burden. These findings underscore the importance of preoperative risk stratification and patient selection to optimize outcome and contain cost.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Philadelphia, Pa.

From the Division of Plastic Surgery and the Department of Surgery, Hospital of the University of Pennsylvania.

Received for publication May 15, 2013; accepted July 15, 2013.

Disclosure: None of the authors has any relevant conflicts of interest to report. No external or internal funding was used for this study.

John P. Fischer, M.D., Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pa. 19104, john.fischer2@uphs.upenn.edu

©2014American Society of Plastic Surgeons