Risk Factors for Pulmonary Complications After Major Oral and Maxillofacial Surgery With Free Flap Reconstruction

Yukie NItta; Masanori Iwasaki; Kanta Kido

doi:10.7759/cureus.50408

Risk Factors for Pulmonary Complications After Major Oral and Maxillofacial Surgery With Free Flap Reconstruction

Cureus. 2023 Dec 12;15(12):e50408. doi: 10.7759/cureus.50408. eCollection 2023 Dec.

Authors

Yukie NItta¹, Masanori Iwasaki², Kanta Kido¹

Affiliations

¹ Division of Dental Anesthesiology, Department of Oral Pathological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, JPN.
² Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, JPN.

Abstract

Background Postoperative pulmonary complications (PPCs) are common and result in increased morbidity and mortality. A variable incidence of PPCs has been reported in patients who have undergone major oral and maxillofacial surgery with free flap reconstruction, which is one of the most extensive forms of head and neck cancer surgery, and perioperative risk factors for PPCs in these patients have not been fully elucidated. Furthermore, the ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score and Gupta risk index have not been investigated in patients undergoing head and neck cancer surgery. This study aimed to identify perioperative risk factors for PPCs after major oral and maxillofacial surgery with free flap reconstruction. Methodology This was a single-center, retrospective cohort study of 118 patients who had undergone major oral and maxillofacial surgery with free flap reconstruction between 2009 and 2020. PPCs were defined as pneumonia, hypoxemia caused by atelectasis, pleural effusion, pulmonary embolism, pulmonary edema, bronchospasm, pneumothorax, and acute respiratory failure. Predictors of PPCs were identified in univariate and multiple Poisson regression analyses. Results The incidence of PPCs was 18.6% (22/118 patients). The most frequent PPC was pneumonia. No preoperative patient-related parameter was identified to predict PPCs. In univariate analysis, the only predictor was anesthesia time ≥1,140 minutes (odds ratio = 3.0, p = 0.036). Multivariable Poisson regression identified two independent predictors of PPCs, namely, anesthesia time ≥1,140 minutes (incidence rate ratio (IRR) = 2.18, 95% confidence interval (CI) = 1.1-4.3, p = 0.024) and a large amount of intraoperative fluid (IRR = 1.00018, 95% CI = 1.000018-1.000587, p = 0.037). Conclusions Patients undergoing major oral and maxillofacial surgery with free flap reconstruction are at high risk of PPCs. Longer anesthesia time and administering a large amount of fluid during surgery were significantly correlated with the risk of PPCs.

Keywords: anesthesia time; free flap reconstruction; oral and maxillofacial surgery; postoperative pulmonary complications; risk factors.