A case-control study of postoperative pulmonary complications after laparoscopic and open cholecystectomy.

Postoperative pulmonary complications (PPC) are common after upper abdominal surgery. The objective of this case-control study was to compare the incidence of PPC after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) within a tertiary care center. Patients were accrued from two sequential clinical trials that evaluated the role of incentive spirometry in the prevention of PPC after abdominal surgery. Included for study were patients with gallstones undergoing elective surgery who had an American Society of Anesthesiologists (ASA) classification < 3. All patients included in the study were encouraged to use an incentive spirometer at least 10 times each hour while awake. Patients with chronic bronchitis were excluded from study, as were patients who received other forms of physical therapy. OC was performed through either a transverse or an oblique incision. There was an equitable dispersion of putative risk factors for PPC between the groups at baseline. PPC were defined as clinical features consistent with collapse/consolidation, an otherwise unexplained temperature above 38 degrees C, plus either confirmatory chest radiology or positive sputum microbiology. The incidence of PPC was 2.7% (1/37) after LC and 17.2% (10/58) after OC (p < 0.05). It is concluded that PPC are less common after laparoscopic cholecystectomy than after open cholecystectomy.