Determinants of Postoperative Pulmonary Complications and Optimization Strategies for Intraoperative Respiratory...

Postoperative pulmonary complications (PPCs) are common after laparoscopic gastrointestinal cancer surgery. This study aimed to identify perioperative risk factors for PPCs and define optimal intraoperative respiratory management strategies.

This prospective observational study enrolled 789 patients undergoing laparoscopic radical surgery for gastrointestinal cancer. Based on the occurrence of PPCs within 7 days postoperatively, patients were categorized into a PPCs group and a non-PPCs group. Univariate analysis and multivariate logistic regression analysis were applied to identify independent influencing factors. Restricted cubic spline analysis was used to model the dose-response relationship between continuous variables and PPCs risk, whereas Kaplan-Meier curves were used to visualize cumulative incidence.

The overall incidence of PPCs was 33.19 %, and the PPCs group exhibited longer total and postoperative hospital stays, elevated rates of unplanned intensive care unit (ICU) transfer, extended ICU stays, and higher hospitalization costs. Upper abdominal surgery (odds ratio [OR], 5.609; P < 0.001), higher smoking intensity (OR 1.025; P = 0.044), and higher mean minilaparotomy-assisted plateau pressure (OR 1.574; P = 0.016) were identified as independent risk factors for PPCs. Higher oxygen saturation upon post-anesthesia care unit (PACU) admission was a protective factor (OR 0.56; P = 0.001). Restricted cubic spline analysis showed a J-shaped relationship between plateau pressure and risk for PPCs. A pressure range of 12 to 14 cmH₂O was associated with the lowest risk, whereas a pressure of 16 cmH₂O or higher significantly increased PPCs risk.

Key modifiable risk factors for PPCs include plateau pressure and smoking intensity. Maintaining minilaparotomy-assisted plateau pressure between 12 and 14 cmH₂O and avoiding levels higher than 16 cmH₂O may be an optimal strategy to reduce PPCs risk. Monitoring immediate postoperative oxygenation also is crucial.