Question 2#
A 65-year-old female is scheduled for spinal surgery. Her pre-op CXR is shown below. She has a past medical history of CAD and HTN, atrial fibrillation. Which of the following is most helpful in predicting her risk of postoperative of respiratory failure?
B. History of atrial fibrillation
C. Nature of the surgery (orthopedic)
D. Age
Correct Answer is A
Comment:
Correct Answer: A
As indicated by the CXR the patient suffers from severe kyphoscoliosis. Kyphosis refers to an excessive curvature of the thoracic spine. The prevalence of kyphosis increases with age due to the combined effects of vertebral fractures, muscle weakness, and degenerative disk disease. The increased curvature leads to a restrictive deficit on pulmonary function testing with decreased TLC and FVC. The restrictive deficit can be associated with atelectasis, intrapulmonary shunt, and arterial hypoxemia. It also places patients at greater risk of postoperative pulmonary complications including respiratory failure and need for mechanical ventilation. Patients with a vital capacity <35% of predicted are at increased risk and will frequently require postoperative ventilation. Atrial fibrillation has a small effect on risk of overall mortality but is not known to specifically increase risk of respiratory failure. In general, orthopedic surgery is associated with a lower complication rate than other procedures. Age >70 is associated with increased mortality in orthopedic patients but this patient is 65.
References:
- Schneider D, von Muhlen D, Barrett-Connor E, sartoris D. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol. 2004;31:747-752.
- Leech J, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141:68-71.
- Taylor JM, Gropper MA. Critical care challenges in orthopedic surgery patients. Crit Care Med. 2006;34:S191-S199.