Risk Factors Analysis Of Postoperative Complications In Patients With Emergency Abdominal Surgery

Objectives To investigate the relationship between intraoperative anesthesia related factors and postoperative complications in emergency abdominal surgical patients,and to analyze the risk factors of these postoperative complications.Methods We retrospectively analyzed 942 emergency general patients undergoing general anesthesia emergency surgery during the period of September 2015 to December 2016 in the First Affiliated Hospital of Nanjing Medical University.This study used hospital surgical anesthesia recording system and an inpatient medical record system to review and collect patients general information including gender,age,previous underlying disease,ASA classification,and intraoperative incidence such as intraoperative hypotension duration,arrhythmia type,hypoxemia.total intraoperative fluid input,blood loss,urine output,operative time,surgical name and anesthesia maintenance methods,and postoperative complications were also collected.Univariate analysis and multivariate logistic regression analysis were applied to analyze the association between preoperative or intraoperative parameters and postoperative complications.Results Among the 942 patients enrolled in the study,there were 226(24.0%)patients who had major postoperative complications within 30 days after surgery.The most common postoperative complications was respiratory complications(31.8%).Univariable analysis suggested that the factors associated with postoperative complications in emergency abdominal surgical patients were age,ASA grade,previous underlying disease,intraoperative hypotension,intraoperative tachyarrhythmia,intraoperative hypoxemia,total intraoperative volume input,intraoperative blood loss,excess of the total volume,excess volume per hour,operation time and operation classification had obvious effect on postoperative complications(P < 0.05).Multivariable analysis showed that after adjusting the role of multiple confounding factors,the independent risk factors of postoperative complications were age(OR1.648,95%CI 1.352-2.008),ASA classification(OR 3.220,95%CI 2.492-4.162),prolonged intraoperative hypotension(hypotension lasting more than 20 minutes)(OR2.031,95%CI 1.256-3.285),intraoperative tachyarrhythmia(OR 2.205,95%CI1.114-4.365)and surgical level(OR 1.895,95%CI 1.306-2.750).Conclusion Emergency abdominal surgery in patients with prolonged intraoperative hypotension(more than 20 minutes)and the occurrence of tachyarrhythmia are independent risk factors for postoperative complications.During the hemodynamic management of emergency surgical patients,systolic blood pressure should be controlled within 20% of the baseline value to reduce the risk of postoperative complications.In addition,increased age,increased ASA grade,and increased operation classification in patients undergoing emergency surgery will significantly increase the risk of postoperative complications.