Prevalence of Postoperative Morbidity in Patients Undergoing Elective Open Major Thoracoabdominal Oncosurgery and Their Correlation with Perioperative Management

Abstract

Background and Aims: Due to rapidly advancing surgical techniques and perioperative management, more patients with comorbidities and poor physical condition are considered for surgical treatment for thoracoabdominal cancers, leading to an increased incidence of postoperative morbidity. We evaluated postoperative morbidity’s prevalence, types and risk factors after thoracoabdominal oncosurgery. Methods: Patients scheduled for elective major thoracoabdominal oncosurgery with an expected duration of more than 2 h and/or predicted blood loss of more than 500 mL were included. On the 3rd and 5th postoperative days (PODs), a postoperative morbidity survey (POMS) was administered by questioning the patients and their caregivers, examining the patients and reviewing patients’ charts, investigations and other records. Results: A total of 323 patients were enroled in the study. POMS-defined morbidity was present in 60.4% of patients on POD 3 and 18.9% of patients on POD 5. The most common morbidity on POD 3 was pain (34.8%), followed by gastrointestinal (GI) (24.2%) and pulmonary (14.3%) complications. On POD 5, the three most common complications were GI (7.8%), pulmonary (6.2%) and pain (5.9%). In multivariate analysis, female gender, hypertension, duration of surgery, intraoperative urine output and delayed extubation were found as independent predictors of POMS-defined morbidity on POD 3. However, on POD 5, multivariate analyses showed that intraoperative inotrope requirement, delayed extubation and intensive care unit stay were independent predictors of POMS-defined morbidity. Conclusion: Postoperative morbidity was present in 60.4% and 18.9% of patients on the 3rd and 5th PODs, respectively, after major thoracoabdominal oncosurgery. Pain and GI complications were the most common morbidity on the 3rd and 5th PODs, respectively.