Postoperative gastrointestinal complications after lung volume reduction operations

Background. Lung volume reduction operations have been shown to improve the quality of life and functional status of some patients with end-stage emph ysema. Methods. Because of a perceived increase in the occurrence of postoperative gastrointestinal (GI) complications, we reviewed our experience in 287 pat ients who had lung volume reduction operations to determine the frequency o f GI complications and to identify risk factors. Results. Using a broad definition of postoperative GI complications (nausea , vomiting, abdominal distension, gastroesophageal reflux, diarrhea, consti pation) there were 137 complications in 67 patients (23%). More severe GI c omplications (bowel ischemia, GI bleeding, perforation, ulceration, ileus, colitis, cholecystitis, pancreatitis) occurred 49 times in 27 patients (9.4 %). Seven of the 27 patients required abdominal operations. Risk factors id entified as predictive of severe complications include diabetes (p = 0.0003 ), lower preoperative hematocrit (p = 0.01), steroid use (p = 0.02), and us e of parenteral meperidine analgesic (p = 0.002). Stepwise logistic regress ion demonstrated that diabetes was 7.02 times more likely to produce severe complications. Other risk factors included steroids (2.81), number of diff erent pain medications (2.59), hematocrit decrease of 5% (1.96), and hemato crit decrease of 1% (1.14). In the patients wit severe GI complications the re were six of 27 (22%) hospital deaths compared with five of 260 (2%) in t hose without GI complications (p = 0.0001). Conclusions. Severe GI complications in patients with emphysema who had lun g volume reduction operations are not uncommon (9.4%) and influence the per ioperative mortality rate. Heightened awareness to identified risk factors will allow earlier recognition, prevention, and perhaps decrease morbidity and mortality rates in these high-risk patients. (Ann Thorac Surg 1999;68:1 029-33) (C) 1999 by The Society of Thoracic Surgeons.