Perioperative risk stratification and strategies for reducing postoperative pulmonary complications following major surgery in resource limited areas: A systematic review

Abstract

Background: Postoperative pulmonary complication can be broadly defined as conditions affecting the respiratory tract that can adversely influence the clinical course of a patient after surgery. Post-operative pulmonary complications are the most frequent reported cause of morbidity and mortality in hospitals. The occurrence of postoperative pulmonary complications in the world is between 5 and 80% with variation attributed to set-up, preoperative and intra-operative risk factors. The incidence of postoperative pulmonary complication was 21.7% in the study area. Postoperative pulmonary complications can be associated with patient-related and procedure related risk factors. Prevention of postoperative pulmonary complication requires comprehensive multidisciplinary approach that includes preoperative risk stratification and optimizations. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol and AMSTAR 2 critical appraisal tool for systematic reviews were used. The literature has reviewed using a multiple and comprehensive database searches including HINARI (Cochrane Library, PubMed and PubMed Central) and Google Scholar to get access for updated evidences on risk stratification and prevention strategies for postoperative pulmonary complications. Discussion: Patients who underwent major surgery should be considered as an increased risk for postoperative pulmonary complications. Patients at risk for postoperative pulmonary complication should be identified before Surgery. Perioperative risk stratification and optimizations are widely used prevention strategies for postoperative pulmonary complications. Conclusion: Screening and identification of patients at high risk for post-operative pulmonary complications are vital during preoperative period. Patients in high risk group should receive pulmonary complication prevention and intervention protocol such as: cessation from smoking, preoperative inspiratory muscle training, goal-directed fluid therapy, chest physiotherapy, postoperative analgesia especially neuro-axial block, early mobilization and early oral intake. Highlights

Preventing Postoperative Pulmonary Complications

“…It is essential to screen patients for their risk of PPCs preoperatively to customize preventive strategies 5,6 . Pfeifer indicated that this risk assessment is essential because perioperative teams do not have the time or resources to provide every potential risk reduction intervention to every patient.…”

“…It is essential to screen patients for their risk of PPCs preoperatively to customize preventive strategies. 5,6 Pfeifer indicated that this risk assessment is essential because perioperative teams do not have the time or resources to provide every potential risk reduction intervention to every patient. "It is important to identify risk in as objective a manner as possible, so that you can efficiently utilize your resources on the patients most likely to benefit: those who are at least at intermediate, if not high, risk for pulmonary complications," he said.…”

“…Postoperative pulmonary complications can be associated with risk factors related to the patient or procedure 2,4,5 . Patient‐related risk factors include abnormal findings on chest radiography, COPD, heart failure, arrhythmia, age of at least 60 years, American Society of Anesthesiologists Physical Status Classification of at least 3, and complete functional dependence.…”