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Pre-Operative Characteristics and Their Role In Prolonged Intubation Following Abdominal Wall Reconstruction

Salvatore Docimo, DO, MS, Konstantinos Spaniolas, MD, Maria Alteri, Andrew Bates, Mark Talamini, Aurora Pryor. Stony Brook Medicine

Introduction: Patients undergoing abdominal wall reconstruction are at an increased risk of developing respiratory complications.  Previous studies have demonstrated that postoperative findings, such as an increase in plateau pressure greater than 6 cm H2O following fascial closure, creates an increased risk of postoperative respiratory complications.  The purpose of this study is to determine if specific preoperative characteristics are an indicator for postoperative respiratory failure.

Method: The 2005-2013 ACS-NSQIP participant use data was reviewed to evaluate post-operative intubation status following abdominal wall reconstruction procedures for ventral hernias. Prolonged intubation, defined as intubation up to 48 hours post-operatively, was evaluated.  Multivariable logistic regression was used to control for patient demographics and comorbidities. Odds ratios (OR) and 95% confidence intervals were reported as appropriate using SPSS.

Results: 4,378 patients were identified.  Majority (51%) of patients were female.  Approximately 2.2% of patients experienced a prolonged intubation. Factors such as a history of severe COPD, ASA 3 or 4, current smoker within one year, and a BMI > 40  were all found to have a significant association with a prolonged intubation. Table 1 demonstrates the statistical findings of each significant variable.

Table 1
Variable Odds Ratio

95% CI Lower

95% CI Upper

 Signifcance
History of Severe COPD 1.79 1.05 3.06 p<0.034
ASA 3 or 4 1.76 1.11 2.77 p<0.014
Current Smoker Within One Year 1.96 1.31 2.93 p<0.001
BMI > 40 kg/m2 2.21 1.09 4.48 0.029

Conclusion: Post-operative prolonged intubation is a known complication of abdominal wall reconstruction. We have demonstrated that pre-operative factors, such as a history of COPD, ASA 3 or 4, current smoker, and a BMI > 40 kg/m2 are factors associated with a prolonged intubation.  Optimization of each  may allow for a reduction in the risk of prolonged intubation in patients undergoing abdominal wall reconstruction.

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87820

Program Number: S001

Presentation Session: Hernia Session

Presentation Type: Podium

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