Abdominal Surgery Patients Research Articles

Evaluation of Intravenous Acetaminophen on Length of Stay in Abdominal Surgery Patients.

The objective of this study is to evaluate the effect of intravenous acetaminophen on length of stay (LOS) in abdominal surgery patients. This retrospective, cohort chart review evaluated patients who underwent colon resection or pancreaticoduodenectomy between January 1, 2010 and August 31, 2013. The primary outcome is postoperative LOS. Secondary outcomes include opioid use, pain scores, and naloxone or laxative use. Patients who received intravenous acetaminophen were compared to patients who did not. A total of 329 patients were included, with 269 in the non-acetaminophen group compared to 60 patients in the acetaminophen group. There was no difference in postoperative LOS (9.2 s vs 9.1 days; P = .90). Postoperative LOS was also similar when controlling for surgery type. The acetaminophen group had reduced opioid consumption in the first 24 hours postoperatively (P = .02). However, pain scores were higher in the acetaminophen group, both in the first 24 hours (P = .007) and throughout the hospital stay (P < .001). Other clinical outcomes were similar between groups. Intravenous acetaminophen was not associated with a decreased postoperative LOS at our institution.

Has High-Frequency Oscillation Technique Any Benefit to Prevent Pulmonary Complications in Abdominal Surgery Patients?

Has High-Frequency Oscillation Technique Any Benefit to Prevent Pulmonary Complications in Abdominal Surgery Patients?

Evaluation of Risk Factors of Surgical Wound Dehiscence in Adults After Laparotomy.

Objectives:The percentage of patients with difficult and prolonged healing of the wound is still high, while the immediate complications such as wound dehiscence occurs in up to 3 % of all treated patients in abdominal surgery. The aim of study was to analyze the risk factors and comorbidities in the group patients undergoing laparotomy and associated with early postoperative wound dehiscence.Methods:The retrospective study included all patients treated surgically at Clinic of General and Abdominal surgery, Clinical Center of the University of Sarajevo in the period from January 1, 2013 until January 1, 2016, with clinically verified surgical wound dehiscence.Results:The results showed statistically proportion of male patients (70%) compared to female (30%). The largest number of respondents were in age group 71-80. Surgical wound infection was evident in 61% of patients, malignant staining in 52%, hypoproteinemia was found in 50% of patients, anemia in 43%, peritonitis in 36% and diabetes in 14% of respondents. Of the total respondents with surgical wound dehiscence, 30 (68%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2=4.399; p=0.036), wound infection (X2=4.112; p=0.043) and malignant diseases (X2=4.016; p=0.045). The frequency of the anemia, peritonitis and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05).Conclusions:The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, malignant disease, anemia and peritonitis. The highest incidence of dehiscence was in patients operated on in medical emergencies, and in patients with malignant disease.

Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

Background:Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs) has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN). The impact of these practices on outcome in Indian scenario is less studied.Aims:This study compares the impact of early EN (within 48 h after surgery) with late EN (48 h postsurgery) on outcomes in abdominal surgical ICU patients.Settings and Design:Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed.Methods:Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS) for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis.Results:Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI); P = 0.003) and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001) were other predictors of prolonged LOS.Conclusions:Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

Peptide-based enteral formula improves tolerance and clinical outcomes in abdominal surgery patients relative to a whole protein enteral formula.

AIMTo compare a dipeptide- and tripeptide-based enteral formula with a standard enteral formula for tolerance and nutritional outcomes in abdominal surgery patients.METHODSA retrospective study was performed to assess the differences between a whole-protein formula (WPF) and a dipeptide- and tripeptide-based formula (PEF) in clinical outcomes. Seventy-two adult intensive care unit (ICU) patients with serum albumin concentrations less than 3.0 g/dL were enrolled in this study. Patients were divided into two groups (WPF group = 40 patients, PEF group = 32 patients). The study patients were fed for at least 7 d, with ≥ 1000 mL of enteral formula infused on at least 3 of the days.RESULTSThe mean serum albumin level on postoperative day (POD) 10, prealbumin levels on POD-5 and POD-10, and total lymphocyte count on POD-5 were significantly higher in the PEF group compared to those in the WPF group (P < 0.05). The average maximum gastric residual volume of the PEF patients during their ICU stays was significantly lower than that for WPF patients.CONCLUSIONDipeptide- and tripeptide-based enteral formulas are more efficacious and better tolerated than whole-protein formulas.

Success of an interdisciplinary educational program on nursing knowledge about epidural analgesia in a critical care setting

Nursing education is a key component to the delivery of safe epidural analgesia in the post-operative critical care setting [1]. An audit of our practice revealed a significant failure rate in epidural analgesia in elective major abdominal surgery patients and a high proportion of missing documentation in cases where epidural analgesia had failed.

The Efficacy of Aromatherapy in the Treatment of Postdischarge Nausea in Patients Undergoing Outpatient Abdominal Surgery.

The purpose of this study was to explore the effectiveness of the aromatherapy product QueaseEASE (QE) for decreasing postdischarge nausea (PDN) in patients undergoing outpatient abdominal surgery. Prospective exploratory study. Informed Consent was obtained preoperatively from a convenience sample of adult patients scheduled for outpatient abdominal surgery procedures. Prior to discharge, subjects were instructed in the use of QE and given instructions on how to rate their nausea on a 0-10 scale. They recorded nausea scales > 0 any time they occurred for the next 24 hours, used the QE, and recorded their nausea scales 3 minutes later. A study nurse called subjects the next day to collect the information. The sample included 70 outpatients who underwent abdominal surgery. Twenty-five participants (36%) reported experiencing PDN and their concomitant use of QE. There was a significant difference in mean age of those reporting PDN (37 years) versus those without nausea (48 years, P = .004) as well as a significant difference in mean intravenous fluid intake during hospitalization of those reporting PDN (1,310mL) versus those without nausea (1,511mL, P = .04). The PDN group had more female participants (72% vs 42%, P = .02), more participants that were less than 50years of age (84% vs 53%, P = .02), and received more opioids (100% vs 76%, P = .006) than the no nausea group. The 25 PDN participants reported 47 episodes of PDN in which they used QE. For all of the 47 PDN episodes experienced, participants reported a decrease in nausea scale (0 to 10) after the use of QE; for 22 (47%) of the PDN episodes experienced, a nausea scale of 0 after using QE was reported. The mean decrease in nausea scale for all 25 participants was 4.78 (±2.12) after using QE. This study found that the aromatherapy QE was an effective treatment of PDN in select same-day abdominal surgery patients.

Postoperative Dehiscence of the Abdominal Wound and Its Impact on Excess Mortality, Hospital Stay and Costs

IntroductionThe objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. MethodsRetrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008–2010. ResultsAmong 323894 admissions for abdominal surgery reviewed there were 2294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14327 euros). ConclusionsCertain demographic and behavioural variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.

Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases.

The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis. The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0-I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30. No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7%, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95% (p = 0.125) and 5-year disease-free survival rates in stages 0-III were 97 and 94% (p = 0.189), 100 and 92% in stage II and 90 and 85% in stage III, respectively. This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.

Hot topics in the perioperative nutritional support therapy in abdominal surgery

Malnutrition is common in the abdominal surgery and affects the recovery of patients. Reasonable nutritional support therapy can improve the prognosis of patients. The nutritional risk screening should be applied to patients within 24 hours of admission. Patients with the nutritional risk and malnutrition should receive the nutritional support by selecting a good timing and way based on the nutritional support planning. Preoperative fasting all night for the majority of patients is not necessary, patients should be allowed to intake low-concentration liquid diet at hour 2 before anesthesia. Patients with preoperative severe malnutrition should be given 7- 10 days of nutritional support therapy. The enteral nutritional therapy was preferred to patients needing postoperative nutritional support therapy, while parenteral nutrition therapy should be supplied to patients with infeasible enteral nutrition or expected target of 60% for enteral nutrition. Individual nutritional support therapy is not necessary for patients without severe concomitant disease. Pharmacological nutrients such as ω-3 polyunsaturated fatty acids and glutamine are beneficial for abdominal surgery and critical patients, which should be used reasonably. Key words: Abdominal surgery; Nutritional support therapy; Perioperative period

Dehiscencia de la laparotomía y su impacto en la mortalidad, la estancia y los costes hospitalarios

IntroductionThe objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. MethodsRetrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. ResultsAmong 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). ConclusionsCertain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.

Influencia de diferentes posiciones corporales en la capacidad vital en pacientes en el postoperatorio abdominal superior

BackgroundThe changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. ObjectiveTo assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. MethodsA cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. ResultsThe sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0kg/m2. The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15±0.03L, p=0.001), the supine to 45̊ (average difference: 0.32±0.04L, p=0.001) and 0° (0.50±0.05L, p=0.001). There was a positive trend between the values of forced VC supine to upright posture (1.68±0.47; 1.86±0.48, 2.02±0.48 and 2.18±0.52L, respectively). ConclusionBody position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.

Influence of different body positions in vital capacity in patients on postoperative upper abdominal

RationaleThe changes in body position can cause changes in lung function, and it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. ObjectiveTo assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. MethodsA cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. ResultsThe sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0kg/m2. The position on orthostasis showed higher values of vital capacity regarding standing (mean change: 0.15±0.03L; p=0.001), the supine to 45 (average difference: 0.32±0.04L; p=0.001) and 0° (0.50±0.05L; p=0.001). There was a positive trend between the values of forced vital capacity supine to upright posture (1.68±0.47; 1.86±0.48; 2.02±0.48 and 2.18±0.52L; respectively). ConclusionBody position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.

Improved oxidative status in major abdominal surgery patients after N-acetyl cystein supplementation.

BackgroundIncreased levels of reactive oxygen species during and after surgery may affect inflammatory response, post-operative adhesion molecule formation, and hemodynamic stability. The glutathione redox cycle is an important regulator in oxidative stress and its reduced forms scavenge free radicals. N-acetyl cysteine, a precursor of reduced glutathione, is considered as a potentially therapeutic wide spectrum agent in clinical practice. We therefore examined whether N-acetyl cysteine improves some biochemical parameters in cancer patients undergoing major abdominal surgery.MethodsThirty-three patients diagnosed with pancreas, stomach, rectum, colon malignancies, and undergoing major abdominal surgery at Ankara Numune Training and Research Hospital were randomly divided into two groups; control (CON) and N-acetyl cysteine (NAC). The NAC group had 1,200 mg N-acetyl cysteine starting two days before the operation day, in addition to isonitrogenous and isocaloric total parenteral nutrition of 1.2 g/kg protein, 25 kcal/kg, and 60:40 carbohydrate/fat ratio. Blood and urine samples were drawn two days before the operation, on operation day, and on the first, third, and fifth days post-operation.ResultsPlasma malondialdehyde was significantly lower in the NAC group (P < 0.001). N-acetyl cysteine treatment did not affect plasma levels of vitamin A, C or E. The NAC group exhibited a higher ratio of reduced glutathione to oxidised glutathione (P = 0.019). Urinary nitrate level was also significantly lower in the NAC group (P = 0.016).ConclusionThe study demonstrated the clinical importance of N-acetyl cysteine supplementation on antioxidant parameters in abdominal surgery patients. In these patients N-acetyl cysteine and vitamin administration can be considered as an effective method for improvement of oxidative status.

Goal-directed cerebral hemodynamic strategy decreases the incidence of postoperative delirium in patients with intracranial hypertension in major abdominal surgery

Increased intracranial pressure (ICP) adversely affects anesthesia due to a disturbed cerebral blood flow. In older patients this disturbance may increase the incidence of postoperative delirium (POD) and may lead to a poor outcome [1]. The standard hemodynamic protocol involves maintaining the mean arterial blood pressure (MAP), but in patients with intracranial hypertension it may not be enough to maintain adequate cerebral perfusion. The purpose of this study was to evaluate the protocol of maintaining cerebral perfusion pressure (CPP) in the prevention of postoperative delirium in older patients in abdominal surgery.

Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS) in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment). Only randomized controlled trials (RCTs) were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs) were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA), body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.

Diagnostic Value of Matrix Metalloproteinase-9 and Tissue Inhibitor of Matrix Metalloproteinase-1 in Sepsis-Associated Acute Kidney Injury.

Sepsis-associated acute kidney injury (SA-AKI) severely impacts morbidity and mortality in surgical patients with sepsis. Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) have an important role in pathophysiology of sepsis but they have been unexplored in SA-AKI. We aimed to investigate the role of MMP-9 and TIMP-1 in septic surgical patients with SA-AKI and to evaluate them as diagnostic biomarkers of SA-AKI. This prospective observational study compared 53 major abdominal surgery patients with sepsis divided into SA-AKI (n = 37) and non-SA-AKI (n =16) group to 50 controls without sepsis matched by age, gender, comorbidities and type of surgery. Blood and urine samples from septic patients were collected on admission to ICU and 24, 48, 72 and 96 h later and once from the controls. The levels of MMP-9, TIMP-1, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1, urea and creatinine were measured. MMP-9/TIMP-1 ratio and disease severity scores, such as Sequential Organ Failure Assessment (SOFA), were calculated. Septic patients with SA-AKI had higher serum TIMP-1 levels and lower serum MMP-9 levels and lower MMP-9/TIMP ratio, compared to septic patients without SA-AKI and controls. The levels of these biomarkers did not change significantly over time. MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio correlated with urea, creatinine, NGAL, and SOFA scores. Moreover, using the area under ROC curve, we showed that TIMP-1 and MMP-9/TIMP-1 ratio, but not MMP-9, were good diagnostic biomarkers of SA-AKI. We report for the first time the potential diagnostic value of TIMP-1 and MMP-9/TIMP-1 ratio in SA-AKI.

Influence of preoperative peripheral parenteral nutrition with micronutrients after colorectal cancer patients.

Background. The inflammatory reactions are stronger after surgery of malnourished preoperative patients. Many studies have shown vitamin and trace element deficiencies appear to affect the functioning of immune cells. Enteral nutrition is often inadequate for malnourished patients. Therefore, total parenteral nutrition (TPN) is considered an effective method for providing preoperative nutritional support. TPN needs a central vein catheter, and there are more risks associated with TPN. However, peripheral parenteral nutrition (PPN) often does not provide enough energy or nutrients. Purpose. This study investigated the inflammatory response and prognosis for patients receiving a modified form of PPN with added fat emulsion infusion, multiple vitamins (MTV), and trace elements (TE) to assess the feasibility of preoperative nutritional support. Methods. A cross-sectional design was used to compare the influence of PPN with or without adding MTV and TE on malnourished abdominal surgery patients. Results. Both preoperative groups received equal calories and protein, but due to the lack of micronutrients, patients in preoperative Group B exhibited higher inflammation, lower serum albumin levels, and higher anastomotic leak rates and also required prolonged hospital stays. Conclusion. Malnourished patients who receive micronutrient supplementation preoperatively have lower postoperative inflammatory responses and better prognoses. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support.

Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs.

Background:Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors’ experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias.Methods:A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed.Results:Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m2; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences—two seromas treated with drainage in the office. After an average of 471 days’ follow-up, none of the patients had recurrence of a bulge or a hernia.Conclusions:For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis

Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation. We searched MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials for observational studies and randomised controlled trials published up to April, 2014, comparing lung-protective mechanical ventilation with conventional mechanical ventilation during abdominal or thoracic surgery in adults. Individual patients' data were assessed. Attributable mortality was calculated by subtracting the in-hospital mortality of patients without postoperative lung injury from that of patients with postoperative lung injury. We identified 12 investigations involving 3365 patients. The total incidence of postoperative lung injury was similar for abdominal and thoracic surgery (3·4% vs 4·3%, p=0·198). Patients who developed postoperative lung injury were older, had higher American Society of Anesthesiology scores and prevalence of sepsis or pneumonia, more frequently had received blood transfusions during surgery, and received ventilation with higher tidal volumes, lower positive end-expiratory pressure levels, or both, than patients who did not. Patients with postoperative lung injury spent longer in intensive care (8·0 [SD 12·4] vs 1·1 [3·7] days, p<0·0001) and hospital (20·9 [18·1] vs 14·7 [14·3] days, p<0·0001) and had higher in-hospital mortality (20·3% vs 1·4% p<0·0001) than those without injury. Overall attributable mortality for postoperative lung injury was 19% (95% CI 18-19), and differed significantly between abdominal and thoracic surgery patients (12·2%, 95% CI 12·0-12·6 vs 26·5%, 26·2-27·0, p=0·0008). The risk of in-hospital mortality was independent of ventilation strategy (adjusted HR 0·71, 95% CI 0·41-1·22). Postoperative lung injury is associated with increases in in-hospital mortality and durations of stay in intensive care and hospital. Attributable mortality due to postoperative lung injury is higher after thoracic surgery than after abdominal surgery. Lung-protective mechanical ventilation strategies reduce incidence of postoperative lung injury but does not improve mortality. None.