Associations between perioperative lung ultrasound score and postoperative pulmonary complications in patients with skull base tumor resection: a retrospective single-center cohort study

BACKGROUND: Postoperative pulmonary complications (PPCs) are common after major surgery and may be particularly frequent after skull base neurosurgery. This study aimed to investigate the incidence of PPCs following skull base tumor resection and the relationship between lung ultrasound scores (LUS) and PPCs in these patients. METHODS: This is a retrospective, single-center, cohort study. Demographic, clinical, and laboratory data were collected from the Hospital Information System. Perioperative lung ultrasound was routinely performed in patients undergoing skull base tumor resection. Only those with complete preoperative and postoperative lung ultrasound data were included. The primary outcome was the incidence of the composite endpoints of PPCs, including pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax and bronchospasm. Associations were reported as adjusted odds ratios (OR) with 95% confidence intervals (CIs). RESULTS: Between March 2022 and June 2024, a total of 140 consecutive patients who underwent elective skull base tumor resection were screened, and 129 were ultimately included in this study. Among them, 40 (31%) patients experienced PPCs within 7 days after surgery. We found that postoperative inferior lung zone LUS score > 0 (adjusted OR 2.59, 95% CI: 1.14-5.89) and delayed extubation (adjusted OR 4.68, 95% CI: 1.76-12.46) were identified as independent risk factors for PPCs with an area under the curve of 0.727 (95% confidence interval: 0.635 to 0.819). CONCLUSION: The incidence of pulmonary complications after skull base tumor resection in adults is as high as 31%. We found that postoperative inferior lung zone LUS score > 0 and delayed extubation were identified as independent risk factors for PPCs after skull base tumor resection. These findings are hypothesis-generating and exploratory, requiring prospective validation in larger cohorts.