TY - JOUR
T1 - Abdominal operations after lung transplantation
T2 - Indications and outcome
AU - Pollard, Thomas R.
AU - Schwesinger, Wayne H.
AU - Sako, Edward Y.
AU - Sirinek, Kenneth R.
PY - 1997
Y1 - 1997
N2 - Objective: To assess the outcomes of abdominal operations in patients with lung transplants and identify adverse risk factors. Design: Matched cohort study. Selling: University referral center. Participants: Twelve lung transplant recipients who required abdominal operations (hereafter referred to as case patients) and 12 age-, sex-, and pulmonary diagnosis-matched lung transplant recipients who had not undergone an abdominal procedure (hereafter referred to as control patients). Interventions: Elective abdominal operations including laparoscopic cholecystectomies (n=5), laparoscopic repair of a colovaginal fistula (n=1), and open colectomy for a benign colovesical fistula (n=1) and urgent operations including bowel resections (n=3), subtotal pancreatectomy (n=1), and hepatorrhaphy for an iatrogenic liver injury (n=1). Main Outcome Measures: Morbidity and mortality. Results: Abdominal operations were performed in 12 (11%) of the patients undergoing lung transplantation at the university referral center since 1987, with an associated mortality rate of 25%. Morbidity and mortality rates of electively performed procedures were 28% and 14%, respectively. An urgent indication for abdominal procedure was associated with 100% morbidity and 40% mortality. Compared with a matched group of 12 control patients, the long-term survival of the case patients was reduced (18% vs 64% at 4 years). Case patients undergoing an abdominal procedure in the posttransplantation period tended to have a higher prevalence of previous rejection (67% vs 25%), a higher perioperative steroid dosage (53 mg/d vs 36 mg/d), and a significantly lower posttransplantational forced expiratory volume in 1 second (FEV1, 1.23 L vs 1.91 L; P<.05). Conclusions: Elective abdominal operations are relatively safe in properly prepared lung transplant recipients. However, laparotomy for urgent surgical conditions is associated with increased morbidity and mortality rates caused in part by the magnitude of the abdominal operation and influenced by the status of the lung transplant as manifested by previous rejection episodes, perioperative steroid dosages, and FEV1 values.
AB - Objective: To assess the outcomes of abdominal operations in patients with lung transplants and identify adverse risk factors. Design: Matched cohort study. Selling: University referral center. Participants: Twelve lung transplant recipients who required abdominal operations (hereafter referred to as case patients) and 12 age-, sex-, and pulmonary diagnosis-matched lung transplant recipients who had not undergone an abdominal procedure (hereafter referred to as control patients). Interventions: Elective abdominal operations including laparoscopic cholecystectomies (n=5), laparoscopic repair of a colovaginal fistula (n=1), and open colectomy for a benign colovesical fistula (n=1) and urgent operations including bowel resections (n=3), subtotal pancreatectomy (n=1), and hepatorrhaphy for an iatrogenic liver injury (n=1). Main Outcome Measures: Morbidity and mortality. Results: Abdominal operations were performed in 12 (11%) of the patients undergoing lung transplantation at the university referral center since 1987, with an associated mortality rate of 25%. Morbidity and mortality rates of electively performed procedures were 28% and 14%, respectively. An urgent indication for abdominal procedure was associated with 100% morbidity and 40% mortality. Compared with a matched group of 12 control patients, the long-term survival of the case patients was reduced (18% vs 64% at 4 years). Case patients undergoing an abdominal procedure in the posttransplantation period tended to have a higher prevalence of previous rejection (67% vs 25%), a higher perioperative steroid dosage (53 mg/d vs 36 mg/d), and a significantly lower posttransplantational forced expiratory volume in 1 second (FEV1, 1.23 L vs 1.91 L; P<.05). Conclusions: Elective abdominal operations are relatively safe in properly prepared lung transplant recipients. However, laparotomy for urgent surgical conditions is associated with increased morbidity and mortality rates caused in part by the magnitude of the abdominal operation and influenced by the status of the lung transplant as manifested by previous rejection episodes, perioperative steroid dosages, and FEV1 values.
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U2 - 10.1001/archsurg.1997.01430310028004
DO - 10.1001/archsurg.1997.01430310028004
M3 - Article
C2 - 9230854
AN - SCOPUS:0030737759
SN - 0004-0010
VL - 132
SP - 714
EP - 718
JO - Archives of Surgery
JF - Archives of Surgery
IS - 7
ER -