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D. Gregory Farwell, MD; Dominic F. Reilly, MD; Ernest A. Weymuller, Jr, MD; Deborah L. Greenberg, MD; Thomas O. Staiger, MD; Neal A. Futran, DMD, MD

Arch Otolaryngol Head Neck Surg. 2002;128:505-511.

Background  Patients with significant medical problems requiring major otolaryngology procedures are at high risk for both medical and surgical complications.

Objective  To identify risk factors associated with perioperative complications in medically compromised patients undergoing major otolaryngology procedures.

Methods  Ninety-three consecutive patients with significant comorbid medical illnesses (eg, diabetes, hypertension) undergoing major head and neck surgical procedures were referred to a medical consultation center for preoperative assessment and medical management. Patient and surgical characteristics as well as perioperative complications were identified and recorded. Univariate and multivariate analyses were performed to determine which characteristics were associated with complications.

Results  Thirty-two patients (34%) had postoperative complications. Twenty-six patients (28%) had serious medical complications, and 18 (19%) had surgical complications. No deaths occurred in the study population. On univariate analysis, the factors associated with all complications included history of hepatitis, flap reconstruction, oncologic surgery, preoperative radiation therapy, preoperative gastrostomy placement, intraoperative transfusion, anesthesia time (8 hours), and those with greater intraoperative fluid replacement and estimated blood losses. Only anesthesia time (8 hours) remained independently significant on multivariate analysis. A history of hepatitis and prolonged anesthesia time were the only independent predictors of medical complications. The only independent predictor of surgical complications was the volume of intraoperative fluid administered.

Conclusions  Prolonged anesthesia times of 8 hours or more, a history of hepatitis, and large-volume intraoperative fluid resuscitations predicted adverse outcomes. Special care must be taken in counseling these patients preoperatively and in caring for them during their operative and postoperative course.

From the Departments of Otolaryngology–Head and Neck Surgery, (Drs Farwell, Weymuller, and Futran), and Internal Medicine (Drs Reilly, Greenberg, and Staiger), University of Washington Medical Center, Seattle.

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