Risk Factors for Respiratory Insufficiency, Arrest and Failure Among Selected Open and Laparoscopic Procedures – Analysis of 90,000+ Procedures

Scott D Kelley, MD, Santosh J Agarwal, BPharm MS, Mary G Erslon, RN MS MBA, Jen Seda, MD, David B Lautz, MD. Covidien, Brigham and Women’s Hospital


Introduction: Appendectomy, cholecystectomy, colectomy and Roux-en-Y gastric bypass are the most common surgical procedures performed using either open or laparoscopic approaches. Respiratory insufficiency, arrest and failure (RIAF) are important perioperative complications, and have become a hospital focus under Medicare’s Inpatient Quality Reporting Program (Patient Safety Indicator #11). Risk factors for RIAF have been examined in a number of studies; however, there has been no estimate of the relative risk of developing RIAF following open versus laparoscopic procedures. We sought to examine independent procedural and patient risk factors for the development of RIAF after open versus laparoscopic abdominal surgery.

Methods: We used the Premier Perspective® (Premier, Inc.) Database 2010 to identify adults who underwent either open or laparoscopic appendectomy, cholecystectomy, colectomy and Roux-en-Y gastric bypass. ICD-9-CM codes were used to identify patients with respiratory insufficiency, arrest and failure (RIAF) and surgical procedures. Multivariate logistic regression analysis was used to determine the risk factors for development of RIAF. Procedure type, open / laparoscopic approach, OR time, provider characteristics, admission category, patient demographics, comorbidity index, obesity, sleep apnea and naloxone administration and comorbidity index, were used as independent variables.

Results: There were 94,154 surgical discharges that met inclusion criteria. RIAF were present in 2,444 (2.6%) of discharges. Appendectomy procedures had the lowest incidence of RIAF. Compared to appendectomy, colectomy procedures had 251% increased risk of developing RIAF, gastric bypass had 166% increased risk and cholecystectomy had 103% increased risk. Open procedures were at 209% increased risk of developing RIAF than laparoscopic procedures (RR: 3.091, 95% CI: 2.767-3.453). Increased age, comorbidity index and non-elective surgeries were associated with increased risk of RIAF. Patient obesity (RR: 1.31, 95% CI: 1.16-1.48) sleep apnea (RR: 1.85, 95% CI: 1.59-2.15) and process-of-care variable increased OR time (RR: 1.04, 95% CI: 1.02-1.06) were associated with higher risk of RIAF development. Naloxone administration (RR: 3.03, 95% CI: 2.61-3.53) is a possible independent indicator of RIAF.

Conclusions: The patient and procedure factors of obesity, sleep apnea, open surgical approach, and increased operative time were independently associated with increased RIAF rate in select abdominal surgery cases. Minimally invasive surgical approaches as well as monitoring for and management of respiratory compromise in this population could reduce the risk of developing RIAF.

Session Number: Poster – Poster Presentations
Program Number: P565
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