Introduction:

Due to increased life expectancy, patients with chronic respiratory failure treated with home ventilation have an increasing likelihood of requiring surgery in their lifetime. Evidence on the safety and feasibility of surgery in this population is scarce.

Methods:

Retrospective analysis of all surgical procedures under general anesthesia in patients included in the chronic home ventilation registry at Ghent University Hospital.

Results:

Between 01/10/2006 and 01/03/2022, 128 surgical procedures were performed on 53 (female: 25) patients with a median age of 52 yr, BMI of 25 kg/m², Charlson Comorbidity Index of 2 and FVC of 1,12 L (34%). 21 patients were ventilated via tracheostomy. The most common cause of respiratory failure was neuromuscular disease and tetraplegia (28 patients).

Most procedures were minor (eg. tracheostomy revisions), but 30 non-elective or emergency procedures (including 7 laparotomies) were registered.

Respiratory complications occurred in 25 procedures (19%) and were associated with length of stay (p < 0.001) and hospital mortality (p = 0.029). Four patients (8%) died, all after emergency surgery, with one death deemed not attributable to the underlying respiratory failure (intracerebral haemorrhage).

The ARISCAT score (median: 19; range: 0 - 86) was significantly associated with respiratory complications, length of stay, and hospital mortality (all p < 0.05).

Conclusion:

Surgery is feasible in chronically ventilated patients, though the risk of respiratory complications and death after surgery, particularly if non-elective, is not negligible. The ARISCAT score was associated with outcomes and appears to be a valuable tool for risk assessment in this population.