title: Incidence, outcome, and risk factors for postoperative pulmonary complications in head and neck cancer surgery patients with free flap reconstructions.
abstract: OBJECTIVE
  Postoperative pulmonary complications (PPCs) are significant problems in patients undergoing radical head and neck cancer surgery with free flap reconstruction. The objective of the study was to identify the incidence, outcome, and risk factors for PPCs We hypothesized that preoperative pulmonary disease and amount of fluid administered during the surgery would be associated with PPCs.
  
  
  METHODS
  A retrospective clinical observational study.
  
  
  METHODS
  A large academic institution.
  
  
  METHODS
  A total of 110 patients who underwent head and neck cancer surgery with microvascular free flap reconstruction between January 1, 2005 and December 31, 2011.
  
  
  METHODS
  No study interventions were performed.
  
  
  METHODS
  PPCs including pulmonary edema, pneumonia, and acute respiratory distress syndrome were clinically diagnosed. Perioperative parameters and outcomes among patients with and without PPCs were compared. Factors predictive of PPCs were identified with univariate and multiple logistic regression analyses.
  
  
  RESULTS
  The incidence of PPCs was 32.7% (36 patients): pulmonary edema in 23.6% (26) and pneumonia in 9.1% (10). No acute respiratory distress syndrome was found. Inhospital mortality was 1.8% (2). No difference was found in survival between the patients with PPCs and those without (1 year survival was 69.4% vs 78.4%; P=.85). The patients with PPCs required longer ventilation support (median, 4 vs 2days; P=.002) and more frequent intensive care unit readmissions (30.3% vs 5.7%; P=.001) and stayed longer in the hospital (median, 17 vs 12days; P=.014). None of the preoperative parameters or intraoperative parameters including pulmonary comorbidity or the amounts of intraoperative fluid/blood administration was found as the factor to predict postoperative pulmonary compilations.
  
  
  CONCLUSIONS
  The incidence of PPCs in patients undergoing radical head and neck surgery was 32.7% in 110 patients. Preoperative pulmonary disease or the amount of fluid administered during the surgery was not associated with PPCs.
authors.affiliation: Assistant Professor, Department of Anesthesiology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: damiand@upmc.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Damian
authors.affiliation: Resident Physician, Department of Anesthesiology, Albert Einstein College of Medicine, New York, NY, USA. Electronic address: jesquena@montefiore.org.
authors.forename: Jacob
authors.initials: J
authors.lastname: Esquenazi
authors.affiliation: Assistant Professor, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: duvvuriu@upmc.edu.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Professor and Chairman, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: johnsonjt@upmc.edu.
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.affiliation: Professor, Department of Anesthesiology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: sakait@upmc.edu.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D058752:Free Tissue Flaps / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods*; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: ARDS; Pneumonia; Post-operative complications; Pulmonary edema; Risk factors