Postoperative respiratory morbidity in chronic obstructive pulmonary disease patients receiving botulinum toxin injection before abdominal wall surgery: A multicentric study.

[BACKGROUND] Botulinum toxin A injection is often used before abdominal wall surgery. Because botulinum toxin A inhibits the lateral abdominal muscles that have a secondary role in the breathing biomechanics, potential concerns regarding postoperative respiratory morbidity in patients with chronic obstructive pulmonary disease have been raised. This study assessed the incidence of postoperative pneumonias after abdominal wall surgery in patients with chronic obstructive pulmonary disease with and without botulinum toxin A injection.

[METHODS] A multicentric (4 centers) cross-sectional study was performed. Consecutive patients with chronic obstructive pulmonary disease who underwent abdominal wall surgery (2013-2024) were included. In case of large or complex hernia, botulinum toxin A was performed 4-8 weeks before surgery if judged necessary. Chronic obstructive pulmonary disease was defined based on the anesthesia preoperative consultation. The primary end point was the rate of postoperative hospital-acquired pneumonias.

[RESULTS] A total of 150 patients with chronic obstructive pulmonary disease were included: median age 68 years (interquartile range: 63-73), 61 women (41%), and median body mass index 29 kg/m (interquartile range: 25-33 kg/m). Sixty patients received botulinum toxin A (40%), and 90 did not receive botulinum toxin A (60%). In the botulinum toxin A group, more patients had loss of domain (28% vs 7%, P < .001), and the median defect size was larger (12 vs 6 cm, P < .001). Fifty-four (90%) and 61 (68%) patients had midline incisional hernias in the botulinum toxin A and non-botulinum toxin A groups (P = .006). Postoperative complications occurred in 26 patients in the botulinum toxin A group (43%) and 33 patients in the non-botulinum toxin A group (37%, P = .413). Postoperative pneumonia incidences were similar in both groups (3/60 vs 4/90, P = .874). On multivariable analysis, component separation was the only predictor of pneumonia (odds ratio: 8.7, 95% confidence interval: 1.7-44.9, P = .010) and not botulinum toxin A (odds ratio: 0.9, 95% confidence interval: 0.2-4.0, P = .920).

[CONCLUSION] Regarding postoperative respiratory morbidity, botulinum toxin A seems safe in patients with chronic obstructive pulmonary disease undergoing abdominal wall surgery.