Incidence and Risk Factors for Postoperative Pulmonary Complications in Endoscopic Skull Base Surgery

Abstract

Objective This study aimed to determine the incidence and risk factors for postoperative pulmonary complications (PPCs) following endoscopic endonasal surgery (ESS).

Design Retrospective review from January 2023 to May 2023.

Setting Tertiary academic center.

Participants One hundred EES cases, of which 97 met the inclusion criteria.

Main Outcome Measures The primary outcome was the incidence of PPC. Univariable and multivariable analyses were used to assess preoperative variables, demographics, and respiratory comorbidities; intraoperative variables of surgery and duration of intubation, endotracheal tube (ETT) size, estimated blood loss (EBL), gastric tube use during surgery; postoperative cerebrospinal fluid (CSF) leak, and length of hospital stay as predictors of PPC.

Results Ninety-seven patients met the inclusion criteria. Twenty-nine developed PPC including increased oxygen requirement (14.4%), pneumonia (9.3%), atelectasis (3.1%), respiratory failure (2.1%), and pulmonary embolism (2.1%). Sixty-four percent were clinically significant PPC. PPC was associated with age (p < 0.007), longer duration of surgery (p < 0.001), longer duration of intubation (p < 0.001), postoperative intubation (p < 0.001), higher EBL (p = 0.022), and longer length of hospital stay (p < 0.001). There was no significant association between PPC and sex (p = 0.705), body mass index (BMI; p = 0.403), gastric tube presence (p = 0.778), ETT size (p = 0.636), and preoperative history of pulmonary disease (p = 0.403).

Conclusion The incidence of PPC in patients undergoing EES is significant. Targeting perioperative risk factors including age ≥65, duration of intubation, postsurgical intubation status, and intraoperative blood loss should have a meaningful impact on decreasing PPC. The contribution of silent intraoperative aspiration during surgery needs to be investigated further in high-risk patient populations.

Keywords

endotracheal tube - aspiration - endoscopic endonasal surgery - postoperative pulmonary complication - pneumonia

Publication History

Received: 31 July 2024

Accepted: 02 February 2025

Accepted Manuscript online:
04 February 2025

Article published online:
27 February 2025

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