Perioperative complications in adults with a posterior mediastinal mass: a retrospective observational cohort study

We studied the incidence of perioperative complications in patients presenting with a posterior mediastinal mass and the possible predictors of complications in these patients.

We conducted a review of the perioperative records of patients aged over 18 years with a posterior mediastinal mass confirmed by computed tomography (CT) who were admitted for surgical procedures relating to the mass during 2004-2014. Perioperative complications were defined as 1) hypoxemia (pulse oximetry < 90% at a fraction of inspired oxygen of 1.0), 2) difficult ventilation (peak pressure > 40 cm H2O or respiratory acidosis with PaCO2 > 60 mmHg), and 3) hemodynamic instability (systolic pressure < 70 mmHg, pulse rate < 40 beats·min(-1) and/or > 120 beats·min(-1) for over five minutes). The review also extended to the first 24 hr postoperatively for cardiovascular and respiratory instability.

Forty-three patients underwent 44 procedures, and the surgery entailed resection of the mediastinal mass in all but one patient. All patients received general anesthesia following intravenous induction. In 43 of 44 cases, intubation was achieved uneventfully with direct laryngoscopy after neuromuscular blockade. The incidence of perioperative cardiopulmonary complications was seven of 44 (16%) procedures. Four of these involved severe hypoxemia, two concerned hemodynamic instability, and two led to postoperative respiratory distress. No cardiovascular collapse or complete airway occlusion occurred. All occurrences of intraoperative complications transpired mid-surgery - six of the seven with the patient in the lateral position. Patients who developed complications were more likely to have a mass with a larger diameter and evidence of airway compression on the preoperative CT scan.

The incidence of perioperative complications in patients with a posterior mediastinal mass is not insignificant; however, no catastrophic airway or cardiopulmonary event was encountered in this study.