Risk Factors Associated With Early Postoperative Respiratory Failure: A Matched Case-Control Study

Jacqueline Stocking, Christiana Drake, J. Matthew Aldrich, Michael K. Ong, Alpesh Amin, Rebecca A. Marmor, Laura Godat, Maxime Cannesson, Michael A. Gropper, Patrick S. Romano, Garth H Utter

Research output: Contribution to journalArticlepeer-review


Background: Postoperative respiratory failure is the most common serious postoperative pulmonary complication, yet little is known about factors that can reduce its incidence. We sought to elucidate modifiable factors associated with respiratory failure that developed within the first 5 d after an elective operation. Materials and Methods: Matched case-control study of adults who had an operation at five academic medical centers between October 1, 2012 and September 30, 2015. Cases were identified using administrative data and confirmed via chart review by critical care clinicians. Controls were matched 1:1 to cases based on hospital, age, and surgical procedure. Results: Our total sample (n = 638) was 56.4% female, 71.3% white, and had a median age of 62 y (interquartile range 51, 70). Factors associated with early postoperative respiratory failure included male gender (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.12-2.63), American Society of Anesthesiologists class III or greater (OR 2.85, 95% CI 1.74-4.66), greater number of preexisting comorbidities (OR 1.14, 95% CI 1.004-1.30), increased operative duration (OR 1.14, 95% CI 1.06-1.22), increased intraoperative positive end-expiratory pressure (OR 1.23, 95% CI 1.13-1.35) and tidal volume (OR 1.13, 95% CI 1.004-1.27), and greater net fluid balance at 24 h (OR 1.17, 95% CI 1.07-1.28). Conclusions: We found greater intraoperative ventilator volume and pressure and 24-h fluid balance to be potentially modifiable factors associated with developing early postoperative respiratory failure. Further studies are warranted to independently verify these risk factors, explore their role in development of early postoperative respiratory failure, and potentially evaluate targeted interventions.

Original languageEnglish (US)
Pages (from-to)310-319
Number of pages10
JournalJournal of Surgical Research
StatePublished - May 2021


  • Adult
  • Elective surgery
  • Matched case-control study
  • Postoperative
  • Respiratory failure
  • Risk factors

ASJC Scopus subject areas

  • Surgery


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