Accuracy of the Preoperative Assessment in Predicting Pulmonary Risk after Nonthoracic Surgery

Abstract

We examined the accuracy of preoperative assessment in predicting postoperative pulmonary risk in a prospective cohort of 272 consecutive patients referred for evaluation before nonthoracic surgery. Outcomes were assessed by an independent investigator who was blinded to the preoperative data. There were 22 (8%) postoperative pulmonary complications. Statistically significant predictors of pulmonary complications (all p < or = 0.005) were as follows: hypercapnea of 45 mm Hg or more (odds ratio, 61.0), a FVC of less than 1.5 L/minute (odds ratio, 11.1), a maximal laryngeal height of 4 cm or less (odds ratio, 6.9), a forced expiratory time of 9 seconds or more (odds ratio, 5.7), smoking of 40 pack-years or more (odds ratio, 5.7), and a body mass index of 30 or more (odds ratio, 4.1). Multiple regression analyses revealed three preoperative clinical factors that are independently associated with pulmonary complications: an age of 65 years or more (odds ratio, 1.8; p = 0.02), smoking of 40 pack-years or more (odds ratio, 1.9; p = 0.02), and maximum laryngeal height of 4 cm or less (odds ratio, 2.0; p = 0.007). Thus, preoperative factors can identify those patients referred to pulmonologists or internists who are at increased risk for pulmonary complications after nonthoracic surgery.

Pre-operative pulmonary assessment for patients with hip fracture

“…Cigarette smoking is a risk factor for PPCs, even in the absence of chronic lung disease or adjusting for other co-morbidities commonly seen in smokers [31, 32]. Current smoker has an additional risk, and there is a correlation between the cumulative amount of smoking and the risk of PPCs [33].…”

“…The presence of COPD increases the risk of PPCs by one- to twofold [20, 32, 46]. The increased risk in COPD patients attributes to the airflow obstruction and the presence of other co-morbidities commonly seen in smokers, such as CHF and weight loss.…”

“…A case-control study showed that there is a trend towards a higher rate of PPCs among patients with OSA undergoing major orthopedic surgery compared with those without [60]. The possible explanations of the increased risk of PPCs are: (1) OSA patients may have coexisting difficult airway and CHF, which may in turn increase the risk of PPCs [32], and (2) the use of anesthetics and analgesics that decrease pharyngeal tone and blunt the ventilatory response to hypoxia, together with supine positioning, may aggravate the severity of OSA during the perioperative period [61]. …”

Review article: Age related alterations in respiratory function — anesthetic considerations

“…42,48,49 For example, in a recent study 48 significant multivariate predictors of pulmonary complications after non-thoracic surgery were age > 65 yr, and a smoking history of more than 40 yr. Pedersen et al 50 found that risk factors for perioperative pulmonary complications included patient age older than 70 yr, chronic obstructive lung disease, major surgery, and the use of muscle relaxants during anesthesia. A recent literature review confirmed that advanced age is a risk factor for postoperative pulmonary complications, even after adjustment for other comorbid conditions.…”

Summary of Consensus Report on Preoperative Evaluation

“…In general, the incidence of postoperative complications (POPCs) was determined to be higher in cases at and over the age of 65 years [4,5].…”