Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients.

C Michael Dunham,Barbara M Hileman,Amy E Hutchinson,Gregory S Huang,Elisha A Chance

doi:10.1186/1471-2253-14-43

C Michael Dunham, Barbara M Hileman + Show 3 more

Open Access

https://doi.org/10.1186/1471-2253-14-43

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Journal: BMC anesthesiology	Publication Date: Jun 9, 2014
Citations: 74	License type: cc-by

Affiliation: St. Elizabeth Youngstown Hospital

Abstract

BackgroundReported perioperative pulmonary aspiration (POPA) rates have substantial variation. Perioperative hypoxemia (POH), a manifestation of POPA, has been infrequently studied beyond the PACU, for patients undergoing a diverse array of surgical procedures.MethodsConsecutive adult patients with ASA I-IV and pre-operative pulmonary stability who underwent a surgical procedure requiring general anesthesia were investigated. Using pulse oximetry, POH was documented in the operating room and during the 48 hours following PACU discharge. POPA was the presence of an acute pulmonary infiltrate with POH.ResultsThe 500 consecutive, eligible patients had operative body-positions of prone 13%, decubitus 8%, sitting 1%, and supine/lithotomy 78%, with standard practice of horizontal recumbency. POH was found in 150 (30%) patients. Post-operative stay with POH was 3.7 ± 4.7 days and without POH was 1.7 ± 2.3 days (p < 0.0001). POH rate varied from 14% to 58% among 11 of 12 operative procedure-categories. Conditions independently associated with POH (p < 0.05) were acute trauma, BMI, ASA level, glycopyrrolate administration, and duration of surgery. POPA occurred in 24 (4.8%) patients with higher mortality (8.3%), when compared to no POPA (0.2%; p = 0.0065). Post-operative stay was greater with POPA (7.7 ± 5.7 days), when compared to no POPA (2.0 ± 2.9 days; p = 0.0001). Conditions independently associated with POPA (p < 0.05) were cranial procedure, ASA level, and duration of surgery. POPA, acute trauma, duration of surgery, and inability to extubate in the OR were independently associated with post-operative stay (p < 0.05). POH, gastric dysmotility, acute trauma, cranial procedure, emergency procedure, and duration of surgery had independent correlations with post-operative length of stay (p < 0.05).ConclusionsAdult surgical patients undergoing general anesthesia with horizontal recumbency have substantial POH and POPA rates. Hospital mortality was greater with POPA and post-operative stay was increased for POH and POPA. POH rates were noteworthy for virtually all categories of operative procedures and POH and POPA were independent predictors of post-operative length of stay. A study is needed to determine if modest reverse-Trendelenburg positioning during general anesthesia has a relationship with reduced POH and POPA rates.

Highlights

Reported perioperative pulmonary aspiration (POPA) rates have substantial variation
The current study findings and literature documentation are consistent with the notion that Perioperative hypoxemia (POH), in Perioperative pulmonary aspiration outcomes Published POPA rates are higher (1.4% to 2.9%) for investigations from voluntary claims reporting databases [5,12,13,14], when compared to studies emanating from comprehensive database reviews (0.01% to 0.9%) [4,6,7,8,9,10,11]
Hospital mortality was greater with POPA and post-operative lengths of stay were increased for POH and POPA patients

Summary

Introduction

Reported perioperative pulmonary aspiration (POPA) rates have substantial variation. Perioperative pulmonary aspiration (POPA) can cause death [1,2,3,4] and may lead to clinically significant morbidities [1,4,5]. It is important to note that reliable estimates of POPA rates are uncertain, in part, due to a lack of prospective data. Adult POPA rates from retrospective comprehensive database reviews have ranged from 0.01% to 0.9% [4,6,7,8,9,10,11], while rates from voluntary claims reporting databases have varied from 1.4% to 2.9% [5,12,13,14]. Besides variability in reported POPA rates, another concern has been the ability to determine, with precision, when pulmonary aspiration has or has not occurred. The diagnosis is more presumptive when there is development of a new intra-operative or post-operative infiltrate seen on a chest x-ray and attendant tachypnea, hypoxia, wheezing, or changes in ventilator airway pressures [10,11,13,15,16]

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