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Introduction: Postoperative acute respiratory failure (ARF) is a major factor of morbidity and mortality in colon and rectal surgery.
Objectives: To evaluate the prevalance of ARF following colorectal surgery and to evaluate the effect of patient characteristics, comorbidities, pathology, resection type, surgical technique and admission type on ARF in colorectal surgery.
Methods: Using the National Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent colon and rectal resection from 2006-2008. Multivariate regression analysis was performed to identify factors predictive of ARF.
Results: A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of acute respiratory failure was 10.42% (elective surgery: 4.51% vs. emergent surgery: 18.59%; p<0.01). Patients who experienced ARF following colorectal surgery had a significantly higher rate of in-hospital mortality (26.84% vs. 1.90%) and a longer mean length of hospital stay (22.31 days vs. 9.32 days) compared with patients without ARF. Using multivariate regression analysis, patient factors including emergent operation (odds ratio [OR]: 2.91), congestive heart failure (OR, 2.51), alcohol abuse (OR, 2.13), pulmonary hypertension (2.01), chronic renal failure (OR, 2.0), chronic lung disease (OR, 1.96), age over 65 (OR, 1.92), diverticulitis (OR, 1.71), liver disease (OR, 1.66), peripheral vascular disease (OR, 1.58), malignant tumor (OR, 1.53), obesity (OR, 1.41) and ulcerative colitis (OR, 1.25) significantly impacted the risk of ARF. Technical factors including total colectomy (OR: 2.66), open procedure (OR, 1.71), , left colectomy (OR, 1.50), and transverse colectomy (OR, 1.41), were also associated with higher risk of ARF. Although male sex (OR: 1.09), teaching hospital (OR, 1.07), Black race (OR: 1.04), and Hispanic race (AOR, 1.03) also had statistically significant impact on rates of ARF, these were less clinically significant than the other factors. There was no association with hypertension, diabetes, smoking, Asian race, sigmoidectomy, proctectomy or Crohn’s disease and ARF.
Conclusions: Respiratory failure is a relatively common complication following colorectal surgery. Emergent surgery is the strongest predictor of acute respiratory failure in colorectal surgery. Surgical approaches such as total colectomy, left colectomy and transverse colectomy, that classically involve upper abdominal incisions, are associated with a higher rate of respiratory failure.