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9 - Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery

Published online by Cambridge University Press:  12 January 2010

By
Michelle V. Conde ,
Ahsan M. Arozullah  and
Valerie A. Lawrence
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Michelle V. Conde
Affiliation:
University of Texas, Health Science Center at San Antonio; San Antonio, Texas
Ahsan M. Arozullah
Affiliation:
University of Illinois, College of Medicine, Chicago, Illinois
Valerie A. Lawrence
Affiliation:
University of Texas, Health Science Center at San Antonio; San Antonio, Texas
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Pulmonary complications are among the most common causes of postoperative morbidity and mortality. In one study of patients undergoing abdominal surgery, pulmonary complications were more frequent than cardiac complications and were associated with significantly longer hospital stays. A cohort study of almost 9000 patients undergoing hip fracture repair showed that serious cardiac and pulmonary complications occurred at similar rates (2% and 3%, respectively) and were associated with similar mortality rates. Additionally, a prospective study of patients, age 70 years, examined predictors of mortality up to 3 years following non-cardiac surgery and found that postoperative pulmonary complications were an independent predictor of decreased long-term survival. These findings confirm the relative clinical importance of the incidence and associated morbidity and mortality of postoperative pulmonary complications.

The true incidence of pulmonary complications depends on the criteria used to define complications and on the type of surgery. The incidence ranged from as low as 5% to as high as 80% for upper abdominal procedures in some series. In other series, the reported incidence of complications following upper abdominal surgery and thoracic surgery varied from 20% to 40%, doubling in cigarette smokers, and approaching 70% in patients with chronic obstructive pulmonary disease (COPD). The criteria used to define complications in different studies have a significant impact on these estimates. Some authors do not report any criteria for complications and others include clinically unimportant microatelectasis or arterial blood gas changes without clinical correlates as complications.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 125 - 141
Publisher: Cambridge University Press
Print publication year: 2006

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