Risk factors for pulmonary complications in the postoperative head and neck surgery patient.
BACKGROUND
Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients. This study investigates potential risk factors related to postoperative pulmonary complications (pneumonia, adult respiratory distress syndrome (ARDS), and prolonged mechanical ventilation) in head and neck cancer patients.


METHODS
Data from 144 major head and neck procedures performed at the University of Washington between 1985 and 1991 were retrospectively reviewed. Univariate and multivariate analysis were used to evaluate preoperative and perioperative variables identified as potential risk factors for postoperative pulmonary complications.


RESULTS
Fifteen percent of patients had a postoperative pulmonary complication, (n = 21: 18 postoperative pneumonia; 2 ARDS; and 4 prolonged ventilation). The most common pneumonia pathogen was Staphylococcus aureus (62%). Univariate analysis identified smoking and weight loss as significant factors associated with pulmonary complications. The variables preoperative blood urea nitrogen, white blood cell count, and operative chest flap closure all approached but did not reach significance. Multivariate analysis of a subgroup of patients identified smoking history and perioperative antibiotic choice as the only independently significant variables.


CONCLUSIONS
Patient smoking history was the primary variable related to postoperative pulmonary problems, with evidence of increasing risk with increased exposure. Other variables added only limited additional risk association information after multivariate analysis.
McCulloch
T M
TM
Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City 52242, USA.
Jensen
N F
NF
Girod
D A
DA
Tsue
T T
TT
Weymuller
E A
EA
D000704:Analysis of Variance; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects