PLASTIC: Prolonged Laparoscopic and Lower Abdominal Surgery Trial – Incidence of Complications

All patients having elective open hernia repairs, prolonged (>180mins) laparoscopic upper abdominal surgery or prolonged (>180mins) lower abdominal abdominal surgery at two Tasmanian hospitals will be be assessed prospectively and daily for the first 14 postoperative days or up to day of discharge, whichever occurs first. Patients will be screened for a postoperative pulmonary complication and prolonged postoperative paralytic ileus using standardized diagnostic screening tools. A postoperative pulmonary complication will be assessed using the Melbourne Group Score Version 3. A positive diagnosis is determined when any four or more of the following criteria; abnormal auscultation, purulent sputum, oxygen desaturation <90% on room air, temperature >38°C, chest imaging of collapse/consolidation, white cell count >11, positive sputum culture, or physician diagnosis or prescription of antibiotics specific for a respiratory infection, are present in a calendar day. A prolonged paralytic ileus was detected when two or more of the following criteria; nausea or vomiting, unable to tolerate oral diet, absence of flatus, abdominal distension, radiological report of gastrointestinal obstruction or ileus, or doctor diagnosis of ileus, occurred in a calendar day on or after the 4th postoperative day.