Elderly, poor function for redo neck surgery

garychleung

PIG Meeting: 13th May 2021

A 73yo female who had a C5/6 foraminotomy in 2015, and then a revision, now for 3rd surgery to same site.

Background

  • Obesity BMI 48
  • HTN
  • NIDDM
  • PE 2017
  • CKD eGFR 45
  • IHD – MI 2001 -> CABG. Angio 2015 – moderate prox LAD dx, grafts patent. Admitted 2018 with stable angina and ED presentation 2020 -> discharged home after -ve trop and ECGs.
  • On salbutamol – patient unaware of indication
  • Distant ex-smoker

Issues

  • Likely OSA – STOPBANG 6-7
  • Severe SOBOE and weekly exertional angina (relieved by GTN)
    • Lost to F/U from cardiologist
    • ? Needs TTE/cardiologist review/stress imaging
    • Nil pedal oedema, orthopnoea, PND

Discussion

  • Should consider further investigation of OSA risk. Note that potential significant waitlist for elective patients.
  • Discussed at cardiology-anaesthetics meeting
    • Reassured by previous angio images pre- and post-bypass
    • Patient able to climb 20 steps up/down without stopping (SOB ++) so felt that low likelihood of significant lesion requiring revascularisation pre-surgery
    • Nil TTE or stress imaging recommended.
  • PFTs indicated?
    • Severe obesity + deconditioning likely causative for SOB
    • PFTs would likely show a restrictive pattern and mildly reduced diffusion
    • Distant ex-smoker, nil resp exacerbations, nil other clear risk factors for severe, modifiable lung disease
  • Low risk surgery in a high risk patient. ? yield from redo, redo surgery.