Analysis of risk factors for postoperative pulmonary complications in head and neck surgery

Abstract

Preoperative pulmonary function tests (PFTs) are unproven in their predictive value for postoperative pulmonary complications. There is a lack of prospective outcome studies upon which to form an opinion, particularly regarding noncavitary surgery. Seventy-three head and neck surgery patients were prospectively evaluated with preoperative PFTs, arterial blood gas analysis (ABG), medical history, and physical examination. Age, anesthesia duration, forced expiratory volume in 1 second (FEV1), peak flow (PF), PaO2, Roizen class, and pack years of smoking were significantly correlated with postoperative pulmonary complications. As similar studies in head and neck surgery patients have not been previously taken, it is hoped that these results will serve as a basis for future endeavors.

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

“…Moreover, we Together with the impairment of laryngeal functions, other factors related to tumour stage, type of surgical resection and host clinical conditions have been reported as additional risk factors for PP, thus suggesting a multifactorial aetiology. 5,6 It is well known that patients who require tracheotomy after major head and neck surgery (always performed during reconstructive laryngectomies) experience a higher incidence of pulmonary complications. Data from the literature indicate that almost 50% of these patients suffer of pulmonary complications including PP, early after surgery despite a course of antibiotic prophylaxis, 4 with elderly subjects and patients with co-morbid respiratory disease being at highest risk.…”

“…4 The aetiology of PP following partial laryngeal surgery, however, is most likely multifactorial considering that several host and tumour factors such as age, obesity, poor preoperative pulmonary function tests, smoking history, type of surgery, extension of disease and blood gas analysis values might play a crucial role in predisposing for PP. 5,6 In the attempt to minimise PP onset patients eligible for partial laryngeal surgery are carefully pre-selected upon pulmonary and performance status, nevertheless PP remains the most important and feared complication even in this selected population, despite antibiotic prophylaxis. 7 The aim of this study is to review our experience with supracricoid and supraglottic laryngectomies at our Institution over a 20 years period in a series of 416 consecutive patients, to investigate possible PP risk factors.…”

Use of Tiotropium Bromide for Pre-operative Treatment in Chronic Obstructive Pulmonary Disease Patients: Comparison with Oxitropium Bromide

“…COPD is considered as a risk factor for early mortality in patients undergoing coronary artery bypass grafting, and the reduced FEV1 has been shown to be an independent risk factor for early mortality (23). Moreover, COPD is a risk factor for neck and head surgery (4) and increases the retention of sputum (24). It has been reported that shortening the duration of surgery may decrease the risk of prolonged ICU stay (5), and pre-operative rehabilitation can prevent long hospital stay (25) (26).…”

Pulmonary Atelectasis After Reconstruction With a Rectus Abdominis Free Tissue Transfer

“…Smoking history, duration of anesthetic, age, and types of surgery are also considered to be risk factors. 4,5 Seikaly et al 1 reported that a pectoralis major myocutaneous flap may increase the frequency of postoperative pulmonary atelectasis. In contrast, Schuller et al 2 contradicted this and found no increased incidence of clinically relevant atelectasis in their patients undergoing pectoralis major myocutaneous flap reconstruction.…”

“…2,4,5 The clinical relevance of this radiologic atelectasis is unknown. Preexisting pulmonary disease and chronic alcoholism were factors that contributed to major morbidity (pneumonia and prolonged ventilation) in our patient population.…”