title: Post-operative pulmonary complications in patients undergoing transoral odontoidectomy and posterior fixation for craniovertebral junction anomalies.
abstract: BACKGROUND
  In patients with craniovertebral junction (CVJ) anomalies, the respiratory system is adversely affected in many ways. The sub-clinical manifestations may get aggravated in the postoperative period owing to anesthetic or surgical reasons. However, there is limited data on the incidence of postoperative pulmonary complications (PPCs) and associated risk factors in such patients, who undergo transoral odontoidectomy (TOO) and posterior fixation (PF) in the same sitting.
  
  
  METHODS
  Five years data of 178 patients with CVJ anomaly who underwent TOO and PF in the same sitting were analyzed retrospectively. Preoperative status, intraoperative variables, and PPCs were recorded. Patients were divided into two groups depending on the presence or absence of PPCs. Bivariate analysis was done to find out association between various risk factors and PPCs. Multivariate analysis was done to detect relative contribution of the factors shown to be significant in bivariate analysis. P < 0.05 was considered as significant.
  
  
  RESULTS
  The incidence of PPCs was found to be 15.7%. Factors significantly associated with PPCs were American Society of Anesthesiologists grade higher than II, preoperative lower cranial nerves palsy and respiratory involvement, duration of surgery, and intraoperative blood transfusion. In multivariate analysis, blood transfusion was found to be the sole contributing factor. The patients who developed PPCs had significantly prolonged stay in ICU and hospital.
  
  
  CONCLUSIONS
  Patients with CVJ anomaly are at increased risk of developing PPCs. There is a strong association between intraoperative blood transfusion and PPCs. Patients with PPCs stay in the ICU and hospital for a longer period of time.
authors.affiliation: Department of Neuroanaesthesiology, All India Institute of Medical, Sciences, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Marda
authors.forename: Mihir P
authors.initials: MP
authors.lastname: Pandia
authors.forename: Girija P
authors.initials: GP
authors.lastname: Rath
authors.forename: Parmod K
authors.initials: PK
authors.lastname: Bithal
authors.forename: Hari H
authors.initials: HH
authors.lastname: Dash
keywords: Craniovertebral junction anomaly; posterior fixation; postoperative pulmonary complications; transoral odontoidectomy