Lung ultrasonography to assess pulmonary complications after head and neck cancer surgery.

[OBJECTIVES] Postoperative pulmonary complications (PPCs) are common after major head and neck cancer surgery. This trial evaluated whether adding daily lung ultrasonography (LUS) to the current diagnostic strategy (clinical evaluation with on-demand chest X-ray [CXR]) improves PPC detection.

[METHODS] In this randomized controlled trial, 196 adults at intermediate/high risk for PPCs undergoing head and neck cancer surgery with free-flap reconstruction were assigned to the current strategy alone or a routine strategy (daily LUS plus current strategy). The primary outcome was the detection rate of clinically relevant PPCs.

[RESULTS] The routine strategy identified significantly more clinically relevant PPCs than the current strategy (92.3% vs. 66.7%, p = 0.035) with higher diagnostic accuracy (AUC: 91.9% vs. 80.4%, p = 0.035). Detection occurred earlier with the routine strategy (median postoperative day 2 vs. 3, p = 0.042). No significant differences were observed in hospital stay or mortality.

[CONCLUSIONS] Incorporating daily LUS into postoperative care enhances the detection of PPCs in patients on general wards after head and neck cancer surgery, without significantly altering short-term clinical outcomes.