title: Pulmonary complications after major head and neck surgery: A retrospective cohort study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Anesthesia, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Petrar
authors.forename: Clark
authors.initials: C
authors.lastname: Bartlett
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hart
authors.forename: Peter
authors.initials: P
authors.lastname: MacDougall
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D009674:Nova Scotia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*