Common postoperative pulmonary complications after hysterectomy for benign indications

Impact of Chronic Obstructive Pulmonary Disease on Laparoscopic Hysterectomy Outcome

Background and Objectives:

Limited research exists on the association between chronic obstructive pulmonary disease (COPD) and morbidity and mortality after laparoscopic hysterectomy. The objective of this study is to examine the following: 1) which demographics and comorbidities are most likely to present concurrently in patients with COPD? 2) Are patients with COPD undergoing laparoscopic hysterectomy at increased risk for development of postoperative complications within 30 days?

Methods:

Retrospective cohort study using data collected from 2007 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program database. All patients who underwent laparoscopic hysterectomy were identified by Current Procedural Terminology codes and stratified based on COPD status. Univariate and multivariate analyses were completed to define odds ratios for postoperative complications within 30 days of laparoscopic hysterectomy.

Results:

This study included 100,518 laparoscopic hysterectomy patients (COPD = 1,130 [1.12%]); (no COPD = 99,388 [98.8%]). Patients with COPD developed more postoperative complications, including pneumonia, reintubation, renal insufficiency, and sepsis. COPD was identified as an independent risk factor for pneumonia (OR, 4.098; 95% CI, 2.222–7.519) and reintubation (OR, 4.348; 95% CI, 2.387–7.937). Patients with COPD had extended length of hospital stay.

Conclusion:

Patients with COPD who undergo laparoscopic hysterectomy have increased risk of experiencing postoperative pneumonia, reintubation, renal insufficiency, and sepsis. Overall, postoperative complication rates remain low, but gynecologists should consider the pulmonary disease status of patients when assessing preoperative risk.

Postoperative Pulmonary Complications Following Laparoscopy

Postoperative pulmonary complications (PPCs) unrelated to anesthesia, especially hydropneumothorax, are rare after gynecologic laparoscopy. Hydropneumothorax can cause respiratory failure and be life-threatening, however. Awareness, prompt diagnosis, and timely intervention are crucial for clinical management. We review the literature for PPCs, including pneumothorax, hydrothorax, hydropneumothorax, and pleural effusion following laparoscopy, and also present a recent case of hydropneumothorax seen at our institution.

Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis

STUDY OBJECTIVES

To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis.

DESIGN

Retrospective review.

SETTING

Tokyo University Hospital between 2006 and 2013.

PATIENTS

Four patients among a total of 2814 patients with a postoperative pneumothorax.

INTERVENTION

Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax.

MEASUREMENTS AND MAIN RESULTS

We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas.

CONCLUSION

The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery.