Factors influencing difficult and failed intubation in patients undergoing gynecologic oncology surgery: a retrospective cohort study

Abstract

Objectives: Difficult and unsuccessful intubation is a leading cause of anesthesia-related morbidity and mortality. This study aimed to investigate the incidence and contributing factors of difficult and unsuccessful intubation in patients undergoing gynecologic oncology surgery, particularly those with significant comorbidities and obesity.

Methods: The study included 653 patients over 18 years of age who underwent gynecologic oncology surgery with planned intubation under general anesthesia between January 1 and July 1, 2024. Data collected included demographic information, number of intubation attempts, personnel involved in intubation, auxiliary methods employed, intubation duration, complications, mouth opening, sternomental distance, thyromental distance, neck mobility, upper lip bite test results, presence of retrognathia or micrognathia, obstructive sleep apnea, and mobile dentures.

Results: The incidence of difficult intubation in our cohort was 7.5%, with no cases of failed intubation. Significant factors associated with increased risk of difficult intubation included body mass index (P=0.008), obstructive sleep apnea (P<0.001), Mallampati score (P<0.001), and mouth opening <4 cm (P<0.001). Among patients with difficult intubation, statistically significant differences were observed for age (P=0.001), ASA score (P=0.002), presence of comorbid conditions(P=0.004), Cormack-Lehane score(P<0.001), sternomental distance <12 cm (P<0.001), thyromental distance <6 cm (P<0.001), limited neck mobility (P<0.001), upper lip bite test results (P<0.001), retrognathia/micrognathia (P<0.001), and presence of dentures (P<0.001).

Conclusions: This study demonstrated that preoperative assessments of body mass index, obstructive sleep apnea, Mallampati score, and mouth opening are significant risk factors for difficult intubation. To reduce the risk of airway-related complications, patients undergoing gynecologic oncology surgery should undergo thorough and careful preoperative evaluation.

Keywords

• Gynecologic oncology
• airway management
• difficult intubation
• predictive
• general anesthesia

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