Postoperative Pulmonary Complications after Craniovertebral Junction Anomaly Surgery: A Prospective Observational Study

Abstract Although respiratory dysfunction is commonly seen in patients with craniovertebral junction (CVJ) anomalies, pulmonary complications following CVJ surgery have not been extensively studied. We studied the incidence of postoperative pulmonary complications (PPCs) after CVJ surgeries and determined the risk factors. We also evaluated the association between the preoperative pulmonary reserve and PPC. This prospective observational study was performed in 41 patients aged 12 to 65 years undergoing surgery for CVJ anomalies. The preoperative pulmonary reserve was assessed with bedside tests (breath holding time [BHT], single breadth count [SBC], and chest expansion) and using a spirometer (forced vital capacity [FVC], forced expiratory volume [FEV1], FEV1/FVC, peak expiratory flow rate). Postoperatively, the incidence of PPC was assessed, and the duration of mechanical ventilation/tracheostomy was noted. Spirometry was repeated after 3 months. The incidence of PPCs was 26.8%, and respiratory support requirement was commonly seen (54.5%). Bedside PFTs, including BHT, SBC, and chest expansion (p = 0.045, 0.001, and 0.012, respectively), along with blood loss (p = 0.013), had a significant association with PPCs. Multivariate analysis revealed a significant association of PPC with blood loss. There was a decline in FEV1 in the postoperative period, followed by improvement after 3 months. The incidence of PPC following CVJ surgery is relatively high (26.8%), and intraoperative blood loss is an independent risk factor. Bedside PFTs like chest expansion may be superior to spirometry tests in predicting the risk of PPC.