Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

Abstract

Background and Aims: Infratentorial neurosurgical procedures are considered high risk for the development of postoperative pulmonary complications (POPCs), prolonging hospital stay of patients with substantial morbidity and mortality. Material and Methods: Patients between the ages of 18 and 65 years, who underwent elective surgery for posterior fossa tumors over a period of two years, were reviewed. Data including American Society of Anesthesiologists physical status; comorbidities like hypertension, diabetes mellitus and hypothyroidism, history of smoking, obstructive sleep apnea, respiratory symptoms, lower cranial nerve (LCN) palsy; intraoperative complications such as hemodynamic alterations suggestive of brain stem or cranial nerve handling, tight brain as informed by the operating neurosurgeon, blood loss, and transfusion; and postoperative duration of mechanical ventilation, tracheostomy, POPCs, length of ICU and hospital stay, general condition of the patient at discharge, and cause of in-hospital mortality were collected. POPC was defined as the presence of atelectasis, tracheobronchitis, pneumonia, bronchospasm, respiratory failure, reintubation, or weaning failure. Results: Case files of 288 patients fulfilling the study criteria were analyzed; POPCs were observed in 35 patients (12.1%). On multivariate analysis, postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy were found to be independent predictors of POPC. Conclusions: The incidence of POPC was 12.1% following infratentorial tumor surgery. The predictors for the occurrence of POPCs were postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy.

Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study

“…Possibly, the early screening for dysphagia and the stringent use of FEES to determine nutrition and therapeutic management might explain the low rate of post-OP pneumonia (n = 1) in our cohort. In contrast to previous studies, we also did not observe any significant differences regarding the length of hospital stay between dysphagic and non-dysphagic patients [4,7,11,22,23].…”

“…Additionally, premature spillage as a result of delayed pharyngeal swallow could be observed just as often. Post-surgical brainstem edema and/or brainstem disturbance impacting the forward signal from the swallowing centers to cranial nerves might be discussed as a potential underlying cause of the latter finding [7].…”

“…The presence of dysphagia may impair the initiation, coordination, or maintenance of swallowing, placing the patient at risk of aspiration. Aspiration is the most clinically significant symptom of dysphagia that is strongly associated with pneumonia, malnutrition, and increased mortality and morbidity [4,[6][7][8]. Dysphagic patients also have a higher likelihood to undergo tracheostomy or gastrostomy tube placement [9].…”

Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study

“…Previous study identified increasing operative time, increasing age, and increasing estimated blood loss, diabetes, chronic obstructive pulmonary disease, preoperative leukocytosis, American Society of Anesthesiologists classification ≥ 3, and infratentorial lesions as risk factors for postoperative pneumonia in postcraniotomy patients 17 – 19 . However, in infratentorial craniotomy with high risk for the development of postoperative pulmonary complications, the predictors for the occurrence of postoperative pulmonary complications were postoperative blood transfusion, lower cranial nerve palsy, prolonged ICU stay and tracheostomy 20 . Our result showed that pulmonary imaging abnormalities on the first postoperative chest CT image was more frequently incident in patients with hypoalbuminemia than in patients without hypoalbuminemia, with the incidence of 39.2%.…”

Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

“…Previous study identi ed increasing operative time, increasing age, and increasing estimated blood loss, diabetes, chronic obstructive pulmonary disease, preoperative leukocytosis, American Society of Anesthesiologists classi cation ≥ 3, and infratentorial lesions as risk factors for postoperative pneumonia in postcraniotomy patients [15][16][17] . However, in infratentorial craniotomy with high risk for the development of postoperative pulmonary complications, the predictors for the occurrence of postoperative pulmonary complications were postoperative blood transfusion, lower cranial nerve palsy, prolonged ICU stay and tracheostomy 18 . Our result showed that pneumonia was more frequently incident in patients with hypoalbuminemia than in patients without hypoalbuminemia.…”