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 emphysema. Methods. Because of a perceived increase in the occurrence of postoperative gastrointestinal (GI) complications, we reviewed our experience in 287 patients who had lung volume reduction operations to determine the frequency of GI complications and to identify risk factors. Results. Using a broad definition of postoperative GI complications (nausea, vomiting, abdominal distension, gastroesophageal reflux, diarrhea, constipation) there were 137 complications in 67 patients (23%). More severe GI complications (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 identified as predictive of severe complications include diabetes (p = 0.0003), lower preoperative hematocrit (p = 0.01), steroid use (p = 0.02), and use of parenteral meperidine analgesic (p = 0.002). Stepwise logistic regression demonstrated that diabetes was 7.02 times more likely to produce severe complications. Other risk factors included steroids (2.81), number of different pain medications (2.59), hematocrit decrease of 5% (1.96), and hematocrit decrease of 1% (1.14). In the patients with severe GI complications there were six of 27 (22%) hospital deaths compared with five of 260 (2%) in those without GI complications (p = 0.0001). Conclusions. Severe GI complications in patients with emphysema who had lung volume reduction operations are not uncommon (9.4%) and influence the perioperative 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.