RISK-FACTORS FOR PULMONARY COMPLICATIONS IN THE POSTOPERATIVE HEAD AND NECK-SURGERY PATIENT

Background: Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients . This study investigates potential risk factors related to postoperat ive pulmonary complications (pneumonia, adult respiratory distress syn drome (ARDS), and prolonged mechanical ventilation) in head and neck c ancer patients. Methods. Data from 144 major head and neck procedures performed at the University of Washington between 1985 and 1991 were r etrospectively reviewed. Univariate and multivariate analysis were use d to evaluate preoperative and perioperative variables identified as p otential risk factors for postoperative pulmonary complications. Resul ts. Fifteen percent of patients had a postoperative pulmonary complica tion, (n = 21: 18 postoperative pneumonia; 2 ARDS; and 4 prolonged ven tilation). The most common pneumonia pathogen was Staphylococcus aureu s (62%). Univariate analysis identified smoking and weight loss as sig nificant factors associated with pulmonary complications. The variable s preoperative blood urea nitrogen, white blood cell count, and operat ive chest flap closure all approached but did not reach significance. Multivariate analysis of a subgroup of patients identified smoking his tory and perioperative antibiotic choice as the only independently sig nificant variables. Conclusions. Patient smoking history was the prima ry variable related to postoperative pulmonary problems, with evidence of increasing risk with increased exposure. Other variables added onl y limited additional risk association information after multivariate a nalysis. (C) 1997 John Wiley & Sons, Inc.