Perioperative risk factors for postoperative pulmonary complications after major oral and maxillofacial surgery with microvascular reconstruction: A retrospective analysis of 648 cases.
BACKGROUND
Postoperative pulmonary complications (PPCs) are common and result in prolonged hospital stays, higher costs and increased mortality. However, data on the incidence and predictors of PPCs after major oral and maxillofacial surgery with microvascular reconstruction are rare. This retrospective analysis identifies perioperative risk factors for postoperative pulmonary complications (PPCs) after major oral and maxillofacial surgery with microvascular reconstruction.


METHODS
Perioperative data and patient records of 648 subjects were analyzed in the period of June 2007 to May 2013. PPCs were defined as pneumonia, atelectasis, pleural effusions, pulmonary embolism, pulmonary oedema, pneumothorax or respiratory failure.


RESULTS
18.8% of all patients developed PPCs. Patient-related risk factors for PPCs were male sex, advanced age, smoking, alcohol abuse, a body mass index >30, American Society of Anaesthesiologists grade higher than 2, pre-existent pulmonary diseases and preoperative antihypertensive medication. Among the investigated procedure-related variables, the length of the operation, the amount of fluid administration and blood transfusion and an impaired oxygenation index during surgery were shown to be associated with the development of PPCs. Using a multivariable logistic regression model, we identified a body mass index >30, American Society of Anaesthesiologists grade higher than 2 and alcohol abuse as independent risk factors for PPCs.


CONCLUSIONS
Several perioperative factors can be identified that are associated with the development of PPCs. Patients having one or more of these conditions should be subjected to intensified postoperative pulmonary care.
Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany. Electronic address: Denys.Loeffelbein@tum.de.
Denys J
DJ
Loeffelbein
Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany.
Annette
A
Julinek
Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany.
Klaus-Dietrich
KD
Wolff
Department of Anaesthesiology, Technische Universität München, Germany.
Eberhard
E
Kochs
Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
Bernhard
B
Haller
Department of Anaesthesiology, Technische Universität München, Germany.
Rainer
R
Haseneder
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D015992:Body Mass Index; D002648:Child; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
Oral and maxillofacial surgery; Postoperative pulmonary complications (PPCs); Risk factors