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Pulmonary complications after major head and neck surgery: A retrospective cohort study

Authors

  • Steven Petrar MD,

    1. Department of Anesthesia , Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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  • Clark Bartlett MD,

    1. Division of Otolaryngology–Head and Neck Surgery , Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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  • Robert D. Hart MD, FRCSC,

    1. Division of Otolaryngology–Head and Neck Surgery , Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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  • Peter MacDougall MD, PhD

    Corresponding author
    1. Department of Anesthesia , Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
    • MD, Department of Anesthesia, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, Room 5452, 1796 Summer Street, Halifax NS, B3H 3A7 Canada
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Postoperative pulmonary complications (PPCs) following head and neck surgery are common. Patients undergoing tracheostomy, free tissue transfer reconstruction, and postoperative ventilation in an intensive care unit (ICU) have a high incidence of PPCs. We sought to define the incidence of PPCs in this cohort and to determine what factors PPCs correlate with.

Study Design:

Retrospective cohort study.

Methods:

Following institutional research ethics board approval, a retrospective review of patients undergoing major head and neck surgery at a Canadian tertiary care center was conducted. The development of PPCs was the outcome of interest. Quality assurance parameters including ICU and hospital lengths of stay, and mortality were also recorded.

Results:

There were 105 patients enrolled, of which 47 (44.8%) sustained one or more PPCs. The most frequent PPC was respiratory failure, accounting for 39 of 94 PPCs observed. Hypertension was the only comorbidity that correlated with development of a PPC (P = .031). Those who sustained PPCs were older than those who did not (median age, 65.6 vs. 58.7 years; P = .005). Development of PPCs correlated with longer ICU and hospital stays. There was increased mortality among patients with PPCs compared to those without (12.8% vs. 1.7%, P = .04).

Conclusions:

Patients undergoing major head and neck surgery are at high risk of PPCs. Advanced age and hypertension significantly correlated with PPCs. PPCs correlate with prolonged ICU and hospital stays, and increased mortality. Further research is needed to define risk factors, useful investigations, and effective optimization strategies to mitigate PPCs.

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