Beyond the Skin: Study Assesses Subcutaneous Emphysema Risk in Laparoscopic Surgery

Subcutaneous emphysema, a common complication of laparoscopic surgery, has garnered increased attention due to its variability in incidence and clinical outcomes. Recently published historical cohort study involving 1,642 adult patients who underwent laparoscopic procedures at Kagoshima University Hospital examined the incidence, outcomes, and risk factors associated with this complication. The study found that 600 patients (37%) developed postlaparoscopic subcutaneous emphysema, with varying degrees of severity categorized as mild (72%), moderate (23%), and severe (6%). Several independent risk factors were identified through multivariable logistic regression analysis. These included female sex, with an odds ratio of 1.82; peak end-tidal carbon dioxide (EtCO2) levels exceeding 45 mm Hg (OR, 2.07); and use of the AirSeal Intelligent Flow System (OR, 3.37). A lower body mass index (BMI) was also associated with increased risk, with a statistically significant trend noted (p < 0.001). Notably, the study highlighted that, despite the high incidence of subcutaneous emphysema, there were no significant complications linked to this condition, reaffirming its relatively benign clinical course. Data collection encompassed demographic information, comorbidities, surgical specifics, and postoperative outcomes, revealing no significant differences in preexisting conditions across patient groups. Moreover, postoperative complications were present in only 20% of patients with subcutaneous emphysema, showing no statistically significant relationship with other postoperative events.

Diagnosis Methodology

The methodology of diagnosing postlaparoscopic subcutaneous emphysema relied on radiological findings, specifically digital chest and abdominal radiographs. This study confirmed that, although the clinical features of postlaparoscopic subcutaneous emphysema are often mild, detailed monitoring is essential for detection through imaging techniques. A significant finding was the interaction between pneumoperitoneum time and type of surgery, with longer operative times correlating only with specific surgical groups, suggesting that procedural characteristics may influence complications. Furthermore, the use of the AirSeal Intelligent Flow System raised considerations regarding its design, potentially increasing the incidence of subcutaneous emphysema due to the method of CO2 insufflation. Overall, this investigation into postlaparoscopic subcutaneous emphysema underscores the importance of recognizing risk factors, particularly in female patients and those with lower BMI, to enhance preventive strategies and ensure timely clinical responses. Enhanced awareness could improve both patient management and outcomes in laparoscopic surgery settings.

Key Points

- A historical cohort study of 1,642 adult patients who underwent laparoscopic procedures indicated that 37% developed postlaparoscopic subcutaneous emphysema, classified into mild (72%), moderate (23%), and severe (6%) cases.

- Independent risk factors associated with the development of subcutaneous emphysema included female sex (odds ratio of 1.82), peak end-tidal carbon dioxide (EtCO2) levels exceeding 45 mm Hg (OR of 2.07), and the use of the AirSeal Intelligent Flow System (OR of 3.37). Additionally, lower body mass index (BMI) was linked to a heightened risk, demonstrating a statistically significant trend (p < 0.001).

- Despite the high incidence of subcutaneous emphysema, the study found no significant complications related to the condition, indicating a relatively benign clinical course, with only 20% of patients experiencing postoperative complications and no significant relationship to other postoperative events.

- Diagnosis of postlaparoscopic subcutaneous emphysema relied on digital chest and abdominal radiographs, highlighting the necessity for thorough monitoring through imaging techniques, as clinical features are often mild.

-  Interaction between pneumoperitoneum time and type of surgery was observed, with longer operative times linked to specific surgical groups, implying procedural characteristics may affect complication rates.

- The study emphasizes the need for heightened awareness of risk factors, particularly in female patients and those with lower BMI, to improve preventive strategies and timely clinical responses in laparoscopic surgery.

Reference –

Onitsuka, K., Godai, K., Tanoue, S. et al. Incidence, outcomes, and risk factors of postlaparoscopic subcutaneous emphysema: a historical cohort study. Can J Anesth/J Can Anesth 72, 152–161 (2025). https://doi.org/10.1007/s12630-024-02859-2