Evaluation of factors effecting respiratory failure in a large contemporary series of patients undergoing thoracoabdominal aortic aneurysm repair

Purpose: In order to evaluate the effect of respiratory failure (defined as respiratory ventilation exceeding 48 hours after operation) on the outcome of thoracoabdominal aortic aneurysm (TAAA) repair and to identify predictors for the development of this complication, we retrospectively evaluated the clinical course of 1100 patients undergoing surgical repair. Methods: From January 11, 1986, through March 13, 1998, 1100 patients underwent thoracoabdominal aortic aneurysm repair. Among the patients studied, 645 (58.6%) were male and 455 (41.4%) were female; there were 710 (64.5%) Crawford extents I and II. 794 (72.2%) had a history of smoking and 454 (41.3%) had chronic obstructive pulmonary disease preoperatively. Of the 1100 patients, 203 (18.5%) developed respiratory failure postoperatively. Results: The in-hospital survival was 73.9% (150/203) for the group of patients who had postoperative respiratory failure, compared to 97.1% (871/897) for the group that did not have respiratory failure (p=0.001). Out of the patients with respiratory failure, 22 (10.8%) required tracheostomy. In addition, 29 (14.3%) patients developed pneumonia and 56 (27.6%) developed adult respiratory distress syndrome. On multivariate analysis, the following variables were associated with respiratory failure (p<0.05): extent I, cerebrovascular disease, postoperative renal insufficiency and renal failure requiring hemodialysis, paraplegia/paraparesis, postoperative bleeding, cardiac complications and stroke. It is important to note that the incidence of preoperative chronic obstructive pulmonary disease was not a significant variable in the development of postoperative respiratory failure. Conclusions: The development of respiratory failure after thoracoabdominal aortic aneurysm repair is associated with an increased mortality. Several well-defined perioperative factors predispose the development of this complication. Clinical Implications: These observations may be of value in selecting patients for elective repair of thoracoabdominal aortic aneurysms.