PRE-OPERATIVE PULMONARY EVALUATION
Abstract
Postoperative pulmonary complications contribute significantly to morbidity and morality insurgical patients. Pulmonary complications occur more frequently than cardiac complications. Thecomplication rates for upper abdominal and thoracic surgery are the highest. A betterunderstanding of the risk factors associated with postoperative pulmonary complications isessential to develop strategies for reducing these complications. In any individual patient thebenefit from a surgical procedure should be weighed against the risks it imposes. When possible,stabilization of respiratory status is advisable before surgery. This article reviews patient andprocedure related risk factors, clinical and laboratory evaluation for preoperative risk assessmentand risk reduction strategies to minimize the complication rates.References
Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp
J, Page CP. Incidence and hospital stay for cardiac and
pulmonary complications after abdominal surgery. J Gen
Intern Med 1995;10:671-8.
Weissman C. Pulmonary complications after cardiac surgery.
Semin Cardiothorac Vasc Anesth 2004;8:185-211.
Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T,
Dhar DK, et al. Postoperative pulmonary complications are
associated with worse short- and long-term outcomes after
extended esophagectomy. J Surg Oncol 2004 1;88:71-7.
Smetana GW. Preoperative pulmonary assessment of the
older adult. Clin Geriatr Med 2003;19:35-55.
Cuypers P, Nevelsteen A, Buth J, Hamming J, Stockx L,
Lacroix H, et al. Complications in the endovascular repair of
abdominal aortic aneurysms: a risk factor analysis. Eur J
Vasc Endovasc Surg 1999;18:245-52.
Ballesta Lopez C, Cid JA, Poves I, Bettonica C, Villegas L,
Memon MA. Laparoscopic surgery in the elderly patient.
Surg Endosc 2003;17:333-7.
Karunakar MA, Shah SN, Jerabek S. Body mass index as a
predictor of complications after operative treatment of
acetabular fractures. J Bone Joint Surg Am 2005;87:1498-
Smetana GW. Preoperative pulmonary evaluation. N Engl J
Med 1999; 340: 937-44.
Ashraf MN, Mortasawi A, Grayson AD, Oo AY. Effect of
smoking status on mortality and morbidity following
coronary artery bypass surgery. Thorac Cardiovasc Surg
;52:268-73.
Warner MA,Divertie MB,Tinker JH. Preoperative cessation
of smoking and pulmonary complications in coronary artery
bypass patient. Anaestheseology 1984;60:380-3.
McAlister FA, Khan NA, Straus SE, Papaioakim M, Fisher
BW, Majumdar SR, et al. Accuracy of the preoperative
assessment in predicting pulmonary risk after nonthoracic
surgery. Am J Respir Crit Care Med 2003;167:741-4
Williams-Russo P, Charlson ME, MacKenzie CR, Gold JP,
Shires GT. Predicting postoperative pulmonary
complications: is it a real problem? Arch Intern Med
;152:1209-13
Goldman L, Caldera DL, Nussbaum SR, Southwick FS,
Krogstad D, Murray B, et al. Multifactorial index of cardiac
risk in noncardiac surgical procedures. N Engl J Med
;297:845-50.
Gilbert K, Larocque BJ, Patrick LT. Prospective evaluation
of cardiac risk indices for patients undergoing noncardiac
surgery. Ann Intern Med 2000;133:356-9.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR,
Hilsenbeck S. Postoperative complications after thoracic and
major abdominal surgery in patients with and without
obstructive lung disease. Chest 1993;104:1445-51.
Kalra M, Buncher R, Amin RS. Asthma as a risk factor for
respiratory complications after adenotonsillectomy in
children with obstructive breathing during sleep. Ann Allergy
Asthma Immunol 2005;94:549-52.
Su FW, Beckman DB, Yarnold PA, Grammer LC. Low
incidence of complications in asthmatic patients treated with
preoperative corticosteroids. Allergy Asthma Proc
;25:327-33.
Jaffer AK, Barsoum WK, Krebs V, Hurbanek JG, Morra N,
Brotman DJ. Duration of anesthesia and venous
thromboembolism after hip and knee arthroplasty. Mayo Clin
Proc 2005;80:732-8.
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van
Zundert A, et al. Reduction of postoperative mortality and
morbidity with epidural or spinal anaesthesia: results from
overview of randomised trials. BMJ 2000;321:1-12.
Kocabas A, Kara K, Ozgur G, Sonmez H, Burgut R. Value of
preoperative spirometry to predict postoperative pulmonary
complications. Respir Med 1996;90:25-33.
American Thoracic Society; American College of Chest
Physicians. ATS/ACCP Statement on Cardiopulmonary
Exercise Testing. Am J Respir Crit Care Med 2003;167:211-
Gass GD, Olsen GN. Preoperative pulmonary function
testing to predict postoperative morbidity and mortality.
Chest 1986;89:127-35.
Milledge JS, Nunn JF. Criteria of fitness for anaesthesia in
patients with chronic obstructive lung disease. BMJ
;3:670-673.
Kearney DJ, Lee TH, Reilly JJ, DeCamp MM, Sugarbaker
DJ. Assessment of operative risk in patients undergoing lung
resection: importance of predicted pulmonary function. Chest
;105:753-59.
Warner MA, Offord KP, Warner ME, Lennon RL, Conover
MA, Jansson-Schumacher U. Role of preoperative cessation
of smoking and other factors in postoperative pulmonary
complications: a blinded prospective study of coronary artery
bypass patients. Mayo Clin Proc 1989;64:609-16
Moller A, Villebro N. Interventions for preoperative smoking
cessation. Cochrane Database Syst Rev 2005;(3):CD002294.
J Ayub Med Coll Abbottabad 2005;17(4)
Guidelines for the diagnosis and management of asthma.
Expert Panel Report 2. National Institutes of Health. National
Heart, Lung, and Blood Institute NIH Publication 1997; NO.
-4051.
Celli BR, Rodriguez KS, Snider GL. A controlled trial of
intermittent positive pressure breathing, incentive spirometry,
and deep breathing exercises in preventing pulmonary
complications after abdominal surgery. Am Rev Respir Dis
;130:12-5.
Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P,
Occella P, et al. Piedmont Intensive Care Units Network
(PICUN). Continuous positive airway pressure for treatment
of postoperative hypoxemia: a randomized controlled trial.
JAMA 2005;293:589-95.
Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J,
Chalmers TC, et al. The comparative effects of postoperative
analgesics therapies on pulmonary outcome: cumulative
meta-analyses of randomized, controlled trials. Anesth Analg
;86:598-612.
Cuschieri RJ, Morran CG, Howie JC, McArdle CS.
Postoperative pain and pulmonary complications: comparison
of three analgesic regimens. Br J Surg 1985;72:495-8.
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