PURPOSE: Post operative course in patients undergoing open abdominal procedures are marked by decreased vital capacity, atelectasis and post operative pain which leads to poor outcomes. The outcomes of patients with lung disease undergoing open abdominal surgery are limited.
METHODS: Using the Nationwide Inpatient Sample from 2008, patients undergoing open abdominal surgery involving liver, spleen, esophagus, stomach, pancreas, kidneys and small and large intestines were identified using ICD-9-CM procedure codes. Patients with chronic obstructive pulmonary disease (COPD - 491,492,496), interstitial lung disease (ILD - 500 to 508) and asthma (493) were also identified using ICD-9 codes. Outcome included all cause in-hospital-mortality, prolonged mechanical ventilation (>96 hours) and length of stay (LOS). Chi-square test and Wilcoxan sign rank test was used to compare mortality and LOS between the 2 groups respectively. Multivariate logistic regression analysis was performed to adjust for demographical and hospital characteristics, primary payer and Charlson's co-morbidity index.
RESULTS: Of 567,759 estimated open upper abdominal surgeries during the year 2008 in the United States, 8.4% had COPD, 2.4% had ILD and 5.1% had asthma. The unadjusted all cause in hospital mortality in patients undergoing these surgeries with no COPD, ILD or asthma was 4.6% while it was 9.3% in COPD, 20.8% in ILD and 2.6% in asthma. The adjusted odds of mortality were 1.40 for COPD (95%Confidence interval(CI): 1.30-1.51), 3.83 for ILD (95%CI: 3.46-4.22) and 0.53 for asthma (95%CI: 0.45-0.62). About 7.7% of COPD, 25.9% of ILD and 2.4% of asthma patients were mechanically ventilated for >96 hours as compared to 3.8% in those without these diseases. The mean LOS was 2 days longer in COPD, 11 days longer in ILD and 1 day shorter in asthma when compared to those without these diseases.
CONCLUSIONS: The mortality and LOS in patients undergoing open abdominal surgery is higher in COPD and ILD and lower in asthma.
CLINICAL IMPLICATIONS: Patients with underlying COPD and ILD have higher mortality and likely to undergo prolonged mechanical ventilation after open upper abdominal surgery.
DISCLOSURE: The following authors have nothing to disclose: Gagan Kumar, Dheeraj Dhotre, Amit Taneja, Jayshil Patel, Rahul Nanchal
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