Relationship between preoperative pulmonary risk assessment and postoperative pulmonary complications in patients undergoing cranial surgery in the presence of chronic disease

Postoperative complications are becoming more and more important than the risk given in preoperative pulmonary evaluation due to the increase in patients requiring surgical intervention. Patients undergoing craniotomy are routinely evaluated preoperatively, but the role of these evaluations in predicting outcomes has not been adequately studied. We aimed to investigate the effect of preoperative pulmonary risk assessment and the type of operation performed on postoperative complications and mortality concerning the presence of chronic disease in patients undergoing cranial surgery in the light of the literature. Preoperative pulmonary consultation data and postoperative pulmonary consultations, if any, of cranial surgery patients who were operated on in the neurosurgery clinic of a tertiary hospital were retrospectively analyzed. 85 (43.8%) of the surgical patients were male and 109 (56.2%) were female, and the average age of 194 people was 74 (35-90). 83 (42.7%) of the patients had at least one chronic disease. Considering the preoperative pulmonary risks, 72 (37.1%) patients were given medium risk. Statistically, the mortality rate was higher in those with ICU beds. Atelectasis in 10 (5.15%) patients, pneumonia in 7 (3.608%) patients, embolism in 3 (1.5%) patients, respiratory failure in 3 (1.5%) and bronchospasm in 2 (1%) patients, respectively. Postoperative pulmonary complications developed in 25 (12.9%) patients. Prediction of respiratory complications with effective preoperative pulmonary evaluation is important in terms of decreasing morbidity and mortality and decreasing the length of hospital stay. Since most of the complications are seen in patients given high risk in the preoperative period, close follow-up of high-risk patients in the postoperative period is important.

PDF

___

1. Delisser HM, Grippi MA. Ch 40 Perioperative respiratory considerations in the surgical patient. Fishman’s Pulmonary Diseases and Disorders,third ed. Fishman AP., Elias JA., Fishman JA., Grippi MA., Kaiser LR., Senior RM. (ed) McGraw-Hill1998;Sf: 619-629.

2. Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018;360:j5916.10. Okada S, Shimada J, Kato D, et al. Long-term prognostic impact of severe postoperative complications after lung cancer surgery. Ann Surg Oncol 2019;26:230–7

3. Manku K, Bacchetti P, Leung J. Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long Term Survival. Anesth Analg. 2003;96:583-9

4. Harari D, Hopper A, Dhesi J et al. Proactive care of older people undergoing surgery(‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age and Ageing. 2007;36:190- 6

5. Lawrence VA, Dhanda R, Hilsenbeck SG et al. Risk of pulmonary complications after elective abdominal surgery. Chest. 1996;110:744-50.

6. Vetter TR, Ivankova NV, Goeddel LA, et al Perioperative Surgical Home Group. An analysis of methodologies that can be used to validate if a perioperative surgical home improves the patient-centeredness, evidencebased practice, quality, safety, and value of patient care. Anesthesiology. 2013;119:1261–74.

7. Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg. 2003;90:1497–504.

8. Smetana GW, Conde MV. Preoperative pulmonary update. Clin Geriatr Med 2008;24:607-24.

9. Zamani A. Selçuk üniversitesi araştırma hastanesi’nde göğüs hastalıkları konsültasyonu yapılan olguların değerlendirilmesi. Tüberküloz Ve Toraks Dergisi 1996;44:139-44

10. Woerlee GM. Common perioperative problems and the anasesthetist: Kluwer academic Publishers 1988;179.

11. Nijbroek SG, Schultz MJ, Hemmes SNT. Prediction of postoperative pulmonary complications. Curr Opin Anaesthesiol. 2019;32:443-51.

12. Erdinç E. Preoperatif Pulmoner Değerlendirme. TTDO Mesleki Gelişim Kursu. 2007:24-7.

13. Balci A, Rakip U, Cengiz A. Preoperative pulmonary evaluation and evaluation of postoperative pulmonary complications in geriatric patients undergoing spinal surgery. Journal of Health, Medicine and Nursing. 2020;78:27-35

14. Anonymous. A rational approach to radiodiagnostic investiga¬tions. World Health Organ Tech Rep Ser. 1983;689:1-49.

15. Smetana GW. Preoperative pulmonary evaluation. N Engl J M 1999;340:937-44.

16. Doyle RL. Assessing and modifying the risk of postoperative pulmonary complications. Chest 1999;115(Suppl 5):77-81.

17. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845-50.

18. Rock AK, Opalak CF, Workman KG, et al. Safety Outcomes Following Spine and Cranial Neurosurgery: Evidence From the National Surgical Quality Improvement Program. J Neurosurg Anesthesiol. 2018;30:328-36.

19. Edwards AE, Seymour DG, McCarthy JM, et al. A 5-year survival study of general surgical patients aged 65 years and over. Anaesthesia 1996;51:3-10.

20. Bharati SJ, Pandia MP, Rath GP, et al. Respiratory complications in the early post-operative period following elective craniotomies. J Neuroanaesth Crit Care. 2015;2:114–20.

21. Manninen PH, Raman SK, Boyle K, et al. Early postoperative complications following neurosurgical procedures. Can J Anaesth. 1999;46:7–14.

22. Sogame LC, Vidotto MC, Jardim JR, et al. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008;109:222–7.

23. Hall JC, Tarala RA, Hall JL, et al. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99:923–7.

24. Smetana GW, Lawrence VA, Cornell JE American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: Systematic review for the American College of Physicians. Ann Intern Med. 2006;144:581–95.

25. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: A guideline from the American college of physicians. Ann Intern Med. 2006;144:575–80.

26. Franceschini J, Sogame LC, Gazzotti MR, et al. Pulmonary function and thoraco-abdominal configuration after elective craniotomy. Neurosurg Q. 2008;18:22–7.

27. Manninen PH, Raman SK, Boyle K, et al. Early postoperative complications following neurosurgical procedures. Can J Anaesth. 1999;46:7–14.

28. Hooda B, Chouhan RS, Rath GP, et al. Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor. J Anaesthesiol Clin Pharmacol. 2019;35:254-60.

29. Sogame LC, Vidotto MC, Jardim JR, et al. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008;109:222–7.

30. Marda M, Pandia MP, Rath GP, et al. Post-operative pulmonary complications in patients undergoing transoral odontoidectomy and posterior fixation for craniovertebral junction anomalies. J Anaesthesiol Clin Pharmacol. 2013;29:200–4.

31. Flexman AM, Merriman B, Griesdale DE, et al. Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. J Neurosurg Anesthesiol. 2014;26:198–204.