Predictors of pulmonary complications after open thoracoabdominal aortic aneurysm repair

BACKGROUND: Open thoracoabdominal aortic aneurysm (TAAA) repair still carries a significant risk of perioperative morbidity and mortality. Among the several postoperative complications reported in literature, postoperative pulmonary complications (PPCs) are the most frequent ones. Since PPCs are strongly associated with unfavorable outcome after major non-cardiac surgery and increase postoperative length of hospital stay and costs, we decided to examine the incidence of PPCs of patients who underwent open TAAA repair in our center and we tried to assess the predictive factors of PPCs. METHODS: Data of all patients who underwent TA repair between January 2009 and March 2015 in our center were recorded. Primary endpoint was to identify the incidence of (PPCs). Independent predictors of PPCs were identified. RESULTS : A total of 372 patients underwent open TA repair during the study period and were included in the analysis. Two-hundred and seven patients (55.6%) developed PPCs. The most frequently observed PPC was mild hypoxia/hypercapnia requiring non-invasive ventilation in the main ward (85% of patients who developed PPCs). Few patients developed severe complications such as pneumonia (2.7%), need for tracheal reintubation (5.1%) and respiratory failure requiring mechanical ventilation for more than 48 hours (9.9%). A multivariate analysis identified as independent predictors of PPCs Crawford's aneurysm type IV, blood losses, savaged blood reinfusion and positive fluid balance. The occurrence of PPCs prolonged both ICU stay and hospital stay while no differences in mortality were observed. CONCLUSIONS: Despite great advances in surgical and anesthesiological techniques, PPCs after TAAA repair remain extremely high. In our experience early application of postoperative non-invasive ventilation for hypoxia helped to have a relatively low number of severe pulmonary complications.