Study Design: Retrospective clinical study.
Objective: To evaluate the predictive factors of postoperative pulmonary complications in unselected scoliotic patients with moderate or severe pulmonary dysfunction.
Background: Many scoliotic patients with moderate or severe pulmonary dysfunction develop postoperative pulmonary complications during hospitalization. However, little is reported about the postoperative pulmonary complication events in this population at the first visit to the hospital.
Methods: Atotal of 88 scoliotic patients with moderate or severe pulmonary dysfunction were identified. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of immediate postoperative pulmonary complications by logistic regression.
Results: Atotal of 16 (18.2%) patients were documented with postoperative pulmonary complications including increased requirement of postoperative ventilatory support (6.3%), atelectasis (31.3%), pneumothorax (6.3%), pneumonia (12.5%), and hypoxemia (43.8%). There were no statistical differences in age, sex, body mass index, abnormal echocardiogram, and prior symptoms between the 2 groups (P>0.05). Of the patients with postoperative pulmonary complications, a slightly higher proportion of patients underwent anterior approach, 2 (12.5%) versus 2 (2.8%) (P=0.091). The Cobb angle before surgery was 102.1±25.5 degree with postoperative pulmonary complications versus 87.7±23.8 degree without postoperative pulmonary complications (P=0.034). Forced vital capacity was 47.0±10.5% versus 52.4±9.0% (P=0.037). Number of levels fused was13.7±2.3 versus 13.1±2.2 (P=0.319). Operation time was 376.8±125.6 minutes versus 350.4±97.8 minutes (P=0.357). Anesthesia time was 415.3±126.8 minutes versus 388.0±97.5 minutes (P=0.341). Estimated blood loss was 1050.0±769.4 mL versus 777.8±460.9 mL (P=0.065), respectively. Logistic regression analysis showed that thoracoplasty correlated with postoperative pulmonary complications (odds ratio 3.81, 95% confidence interval 1.11-13.16).
Conclusions: Thoracoplasty is the only independent predictor of postoperative pulmonary complications. However, the abnormal echocardiogram, prior symptoms, forced vital capacity, and other clinical characteristics play a less relevant role in the prediction of postoperative pulmonary complications.
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
No funds were received to support this work. No benefits in any form have been or will be received from any commercial party related directly and indirectly to the subject of this manuscript.
Reprints: Jianxiong Shen, MD, Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing 100730, China (e-mail: firstname.lastname@example.org).
Received for publication April 9, 2009; accepted June 29, 2009