Incidence and risk factors of postoperative pulmonary complications for the elderly patients undergoing elective craniotomy

Abstract

Objective To determine the incidence of postoperative pulmonary complications (PPCs) and to evaluate its relationship to perioperative variables in the elderly patients (≥65 years) undergoing elective craniotomy. Methods A retrospective analysis was conducted on 299 patients who underwent intracranial tumor resection or intracranial aneurysm clipping from January to December 2016 at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University. All patients were at least 65 years old. The patients′ data of preoperative, intraoperative and postoperative periods were collected to study the incidence of postoperative pulmonary complications and risk factors of postoperative pulmonary infections. Results Postoperative pulmonary infection occurred in 48 (16.1%) patients and 18 (6.0%) patients had respiratory failure. Five patients died and the mortality rate was 1.7%. Fifty (16.7%) patients were diagnosed as lower extremity deep venous thrombosis. Two of them had pulmonary embolism and 1 died. The patients were divided into 2 groups according to whether there was pulmonary infection. There was a statistically significant difference in the duration of hospital stay (P=0.006), hospitalization costs (P=0.007) and lower extremity deep venous thrombosis (P<0.001) between the 2 groups. Predicting factors for postoperative pulmonary infection assessed by multivariate analyses were as follows: the age≥70 years (OR=2.024, 95%CI: 1.079-3.797, P=0.028), chronic lung disease (OR=8.951, 95%CI: 3.649-21.960; P<0.001), intraoperative infusion≥3 000 ml (OR=2.781, 95%CI: 1.451-5.239; P=0.002) and retaining of tracheal catheter after surgery (OR=5.187, 95%CI: 2.510-10.719, P<0.001). Conclusions The pulmonary infections are the most common PPCs in the elderly patients undergoing elective craniotomy. Postoperative pulmonary infection could result in prolonged hospitalization and increased hospitalization costs. Risk factors for pulmonary infections may include the age≥70 years, chronic lung disease, intraoperative infusion ≥ 3 000 ml and retaining of tracheal catheter after surgery. Key words: Aged; Neurosurgical procedures; Postoperative complications; Pulmonary infection