Adult respiratory distress syndrome after microvascular free tissue reconstruction in head and neck malignancy

Logan, Sheena; Rogers, Simon N.; Richardson, D.; Vaughan, E.D.; Brown, James S.

doi:10.1016/s0266-4356(98)90649-0

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…Reports on the incidence of PPCs in patients undergoing major oral surgery with free flap reconstruction vary, likely because of the use of different definitions of PPCs. For example, Logan et al reported a 1.8% incidence of PPCs, which they defined as adult respiratory distress syndrome [ 7 ]. Meanwhile, Damian et al reported a 32.7% incidence of PPCs, which they defined as pulmonary edema, pneumonia, pneumothorax, pulmonary embolism, or adult respiratory distress syndrome [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have explored various preoperative risk factors for PPCs in patients undergoing major oral surgery with free flap reconstruction. Risk factors associated with this type of surgery include advanced age, male sex, higher BMI, longer smoking history, low serum albumin, pulmonary comorbidity, alcohol abuse, and low preoperative metabolic equivalents [ 1 , 2 , 4 , 7 , 10 , 12 , 14 - 16 ]. Several studies have found that a generally poor physical condition (higher ASA grade) is a risk factor for PPCs [ 1 , 4 , 10 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported a variable incidence of PPCs among patients undergoing head and neck cancer surgery (HNCS), especially major oral surgery with free flap reconstruction, which is one of the most extensive forms of HNCS. The reported incidence rate for PPCs after HNCS ranges from 1.9% to 44.8% [ 7 , 8 ]. However, information on risk factors for PPCs after major oral and maxillofacial oral surgery with free flap reconstruction is scarce, especially concerning intraoperative indices, such as anesthesia time [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Pulmonary Complications After Major Oral and Maxillofacial Surgery With Free Flap Reconstruction

NItta,

Iwasaki,

Kido

2023

Cureus

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Background Postoperative pulmonary complications (PPCs) are common and result in increased morbidity and mortality. A variable incidence of PPCs has been reported in patients who have undergone major oral and maxillofacial surgery with free flap reconstruction, which is one of the most extensive forms of head and neck cancer surgery, and perioperative risk factors for PPCs in these patients have not been fully elucidated. Furthermore, the ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score and Gupta risk index have not been investigated in patients undergoing head and neck cancer surgery. This study aimed to identify perioperative risk factors for PPCs after major oral and maxillofacial surgery with free flap reconstruction. Methodology This was a single-center, retrospective cohort study of 118 patients who had undergone major oral and maxillofacial surgery with free flap reconstruction between 2009 and 2020. PPCs were defined as pneumonia, hypoxemia caused by atelectasis, pleural effusion, pulmonary embolism, pulmonary edema, bronchospasm, pneumothorax, and acute respiratory failure. Predictors of PPCs were identified in univariate and multiple Poisson regression analyses. Results The incidence of PPCs was 18.6% (22/118 patients). The most frequent PPC was pneumonia. No preoperative patient-related parameter was identified to predict PPCs. In univariate analysis, the only predictor was anesthesia time ≥1,140 minutes (odds ratio = 3.0, p = 0.036). Multivariable Poisson regression identified two independent predictors of PPCs, namely, anesthesia time ≥1,140 minutes (incidence rate ratio (IRR) = 2.18, 95% confidence interval (CI) = 1.1-4.3, p = 0.024) and a large amount of intraoperative fluid (IRR = 1.00018, 95% CI = 1.000018-1.000587, p = 0.037). Conclusions Patients undergoing major oral and maxillofacial surgery with free flap reconstruction are at high risk of PPCs. Longer anesthesia time and administering a large amount of fluid during surgery were significantly correlated with the risk of PPCs.

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Section: Discussionmentioning

confidence: 99%