Preoperative Pulmonary Evaluation

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

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.

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in pediatric anesthesia-Part 1 patient and surgical factors

Pediatric surgery cases are increasing worldwide. Within pediatric anesthesia, perioperative respiratory adverse events are the most common precipitant leading to serious complications. They can have intraoperative impact on the surgical procedure itself, lead to premature case termination and in addition may have postoperative impact resulting in longer hospitalization stays and costs. Although most perioperative respiratory adverse events can be promptly detected and managed, and will not lead to any sequelae, the risk of life-threatening progression remains. The incidence of respiratory adverse events increases in children with comorbid respiratory and/or nonrespiratory illnesses. Optimized perioperative patient care, risk-stratified care level choice, and practitioners with appropriate training allow for risk mitigation. This review will discuss patient and surgical risk factors with a focus on common patient comorbid illnesses and review scoring systems to quantify risk.

Prediction of postoperative pulmonary complications using preoperative controlling nutritional status (CONUT) score in patients with resectable non-small cell lung cancer

Postoperative pulmonary complications (PPCs) significantly impact surgical outcome. We investigated the predictive ability of controlling nutritional status (CONUT) for PPC after lung resection in patients with non-small cell lung cancer (NSCLC). We retrospectively reviewed data of 922 patients with NSCLC who underwent complete resection from January 2016–December 2017. We analyzed the frequency and characteristics of PPCs and compared receiver operating characteristic (ROC) curves of various prognostic models to predict PPCs. A CONUT score higher than 1 was considered as a high CONUT score. Total incidence of PPCs was 8.6% (n = 79). The proportion of pneumonia was significantly larger in the high CONUT group (P < 0.05). The CONUT consistently had a higher area under curve (AUC) value (0.64) than other prognostic models (prognostic nutritional index (PNI): AUC = 0.61, Glasgow prognostic score (GPS): AUC = 0.57, and assessment of respiratory risk in surgical patients in Catalonia (ARISCAT): AUC = 0.54). Multivariate analysis identified underweight [Odds ratio (OR) = 4.57, P = 0.002] and high CONUT score (OR = 1.91, P = 0.009) as independent PPCs prognostic factors. One-year mortality rate for high CONUT score was significantly higher (hazard ratio = 7.97; 95% confidence interval, 1.78–35.59). Preoperative CONUT score is an independent predictor of PPCs and 1-year mortality in patients with resectable NSCLC.