2019 FSA Posters

P034: PULMONARY SARCOIDOSIS AND MORTALITY: A CASE REPORT AND REVIEW OF STRATEGIES TO REDUCE POSTOPERATIVE PULMONARY COMPLICATIONS
Lucas Bannister, Basma Mohamed; University of Florida

Introduction:  Postoperative pulmonary complications (PPCs) are collectively a major contributor to perioperative morbidity and mortality, length of stay, and healthcare cost. Sarcoidosis and all of the pulmonary disorders collectively referred to as interstitial lung diseases (ILDs) may be underappreciated as underlying conditions that adversely affect patients’ risk of these complications. We present a case of a PPC resulting in mortality in a patient with pulmonary sarcoidosis and review the perioperative management of patients with ILD.

Case:  A 76-year-old female with HTN, asthma, pulmonary sarcoidosis, GERD, and failed back surgery presented for L2-3 extension of previous spinal fusion. The patient was seen in pre-operative clinic three days prior to surgery. Vitals were all within normal range except for SpO2 of 94% on RA. The patient reported being active (METs > 4) prior to one month of lower extremity symptoms, and outside imaging reports from six months prior were obtained, including chest CT showing “stable interstitial changes characteristic of sarcoid” and TTE showing normal LV and RV size and function with right ventricular systolic pressure (RVSP) of 34mmHg. The patient underwent surgery, and intra-operative course was unremarkable. In PACU, patient had hypoxemia treated with supplemental oxygen and was eventually sent to the surgical ICU. Her post-operative course was complicated by severe pulmonary HTN, acute hypoxic respiratory failure requiring intubation, and PEA arrest on POD 4 and, ultimately, withdrawal of life-sustaining measures due to inability to wean from mechanical ventilation on POD 9.

Discussion:  There is a paucity of data regarding the impact of ILD on the incidence of PPCs, and there currently exists no standardized approach to the pre-operative workup and optimization of patients with ILD, likely owing to the wide heterogeneity of this group of disorders. A routine and reassuring pre-operative assessment may mask significant underlying impairment of cardiopulmonary reserve in patients with restrictive lung physiology. A high index of suspicion of pulmonary impairment (similar to OSA and other chronic obstructive pulmonary diseases) should be maintained for ILD patients, and recommended strategies to reduce PPCs may help guide the anesthesiologist in tailoring a safe anesthetic in such cases.