Risk Factors For Postoperative Pulmonary Complications In Patients Undergoing Laparoscopic Pancreaticoduodenectomy

Laparoscopic pancreaticoduodenectomy is the biggest operation of abdominal surgery with high incidence of postoperative complications and mortality.Since 1992,the first case of LPD was performed in foreign countries,and its safety and practicality has been confirmed after 20 years development.Department of hepatic surgery in our hospital specializes in laparoscopic technique.Our hospital actively carried out the first case of LPD in 2014 and nearly 200 patients underwent this surgery until now,which makes the technology ranking the leading position in China.Laparoscopic CO₂ pneumoperitoneum has strong impacts on the patient’s respiratory system.Long time laparoscopic operation is easy to appear pulmonary infection,atelectasis and other postoperative pulmonary complications.Most of the patients who underwent the surgery are elderly,they have obviously changed physiological function of respiratory system and decreased breathing reserve,which increases the risk of postoperative pulmonary complications.Through literature review,there are few reports on the postoperative pulmonary complications of LPD.In this study,we retrospectively analyzed the clinical data of patients undergoing LPD,and the preoperative,intraoperative and postoperative data were analyzed by the software statistically.Finally,the risk factors of postoperative pulmonary complications in patients underwent LPD were summarized through the interpretation results so as to provide reference for more reasonable anesthesia management during longtime laparoscopic operations.Objective: The retrospective study aims to identify the risk factors of postoperative pulmonary complications in patients undergoing laparoscopic pancreaticoduodenectomy and further improve perioperative anesthesia management and reduce the incidence of postoperative pulmonary compli-cations.Methods:A retrospective survey was undertaken on 100 patients who had underwent LPD operation between October 2015 to January 2017 in the department of hepatic surgery of the second hospital of Hebei Medical University.The patients were divided into two groups: pulmonary complication group（P group）and non-pulmonary complication group（NP group）.A total of 19 items of information such as gender,age,BMI,ASA classification,smoking,chronic obstructive pulmonary disease（COPD）,hypertension,diabetes,coronary heart disease,liver functional grading,inspiration fraction of oxygen（FiO₂）,blood transfusion,intraoperative fluid volume,intraoperative warming,application of ulinastatin during operation,postoperative analgesia,ICU observation,operation time,postoperative hospitalization time were collected.The difference in perioperative various clinical indexes was compared between two groups.We used logistic regression analysis to explore the risk factors of postoperative pulmonary complications.Results:1 33 of 100 operation patients suffered postoperative pulmonary complications,and the incidence was 33%.2 Single factor analysis showed: The incidence of smoking,COPD,100% FiO₂,application of ulinastatin during operation,ICU observation in P group were 30.3%,33.3%,84.8%,9.1%,66.7%,which in NP group were 9.4%,14.9%,50.7%,29.9%,17.9%,respectively.These five variables were statistically significant（P<0.05）.3 The results of t test: Age,postoperative hospitalization time in P group were（63.30±8.33）years old,（29.91±20.89）day,which in NP group were（58.16±9.52）years old,（19.30±8.18）day,respectively.There was significant difference between the two items（P<0.05）.4 Above seven variables which were statistical significance（P<0.05）were screened to multivariate logistic regression analysis.The results displayed that three independent factors of postoperative pulmonary complications（P<0.05）: smoking（OR=0.218;95%CI: 0.068-0.694;P=0.010）;COPD（OR=0.043;95%CI: 0.008-0.223;P=0.000）;100% FiO₂（OR=0.167;95%CI: 0.038-0.740;P=0.018）.Conclusions:There were three independent factors of postoperative pulmonary complications in patients undergoing LPD: smoking,COPD,100% FiO₂.Intervention of these three factors may reduce the incidence of postoperative pulmonary complications in patients undergoing LPD.No history of smoking and COPD,suitable FiO₂ could significantly shorten the length of hospital stay in patients undergoing LPD,which is beneficial to the recovery of patients after operation.