Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Zyad J. Carr

Abstract

The literature on perioperative outcomes for patients with systemic sclerosis (SSc) is sparse due to the rarity of the disease. The primary aim of this study was to describe the incidence of various perioperative complications in a single-center population of SSc patients. 278 SSc patients with 605 unique surgical encounters between January 1, 2010 and January 1, 2020 were included in the study. Data on airway management, intraoperative adverse events (vasopressor use, pulmonary aspiration, cardiac arrest, dysrhythmias, bronchospasm, anaphylaxis, and post-induction hypoxia, hypotension, bradycardia or tachycardia), and 30-day postoperative complications (stroke, pneumonia, myocardial infarction, atrial fibrillation, wound infection, other infections, ileus, acute kidney injury, deep vein thrombosis/pulmonary embolism, congestive heart failure, hospital readmission, and mortality). Gastroesophageal reflux disease (82.4%), hypertension (57.9%), and pulmonary hypertension/pulmonary arterial hypertension (52.5%) were common comorbidities in the SSc patients. Poor views during direct laryngoscopy were noted in 10.9% of cases, but the first attempt success rate exceeded 93%. Video laryngoscopy was used in 24.1% of cases with a first attempt success rate of 96.8%. Microstomia was an independent predictor of difficult airway designation (adjusted odds ratio 3.42, p = 0.029). The most frequent intraoperative adverse event was vasopressor use (34.0%). The in-hospital complication rate was 14.7% while the composite 30-day postoperative complication rate was 27.6%. Pneumonia was a common postoperative complication that occurred after 5.5% of the procedures and caused 40% of the mortality. A composite of pulmonary hypertension and pulmonary arterial hypertension was an independent predictor for 30-day postoperative pneumonia (adjusted odds ratio 2.61, p = 0.033), congestive heart failure (adjusted odds ratio 4.15, p = 0.014), and mortality (adjusted odds ratio 3.57, p = 0.018). This study characterized perioperative outcomes for patients with SSc. While there were certain challenges with airway management, namely poor views, first attempt success rates for direct and video laryngoscopy were high, implying that modern techniques have improved airway management for this patient population. Pulmonary hypertension was a significant risk factor for 30-day postoperative pneumonia, which posed a serious risk to our SSc cohort.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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