Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians

Abstract

Postoperative pulmonary complications play an important role in the risk for patients undergoing noncardiothoracic surgery. Postoperative pulmonary complications are as prevalent as cardiac complications and contribute similarly to morbidity, mortality, and length of stay. Pulmonary complications may even be more likely than cardiac complications to predict long-term mortality after surgery. The purpose of this guideline is to provide guidance to clinicians on clinical and laboratory predictors of perioperative pulmonary risk before noncardiothoracic surgery. It also evaluates strategies to reduce the perioperative pulmonary risk and focuses on atelectasis, pneumonia, and respiratory failure. The target audience for this guideline is general internists or other clinicians involved in perioperative management of surgical patients. The target patient population is all adult persons undergoing noncardiothoracic surgery.

Pre-operative pulmonary assessment for patients with hip fracture

“…For example, Arozullah and colleagues developed a validated pulmonary risk index predictive of pneumonia and respiratory failure after non-cardiothoracic surgery [22–24]. All risk factors for PPCs can be classified into patient-related risk factors and procedure-related risk factors (Table 2) [25]. …”

“…Impaired sensorium is defined as either (1) an acutely confused or delirious patient who is able to respond to verbal stimulation, mild tactile stimulation, or both, or (2) a patient with mental status changes, delirium, or both in the context of current illness, modestly increase the risk of PPCs (OR 1.39) [21]. The OR of PPCs for total dependence and partial dependence were 2.51 and 1.65, respectively [25]. …”

“…Although other chronic lung diseases such as interstitial lung disease, neuromuscular disease, chest wall deformity, or pulmonary artery hypertension may increase the risk of PPCs after lung resection and other non-cardiothoracic surgery [65, 66], there is no strong evidence suggesting an increased risk for pulmonary complications after hip fracture surgery among patients with these conditions [25]. …”

“…Preoperative tests such as chest radiograph, spirometry, or arterial blood gas should not be ordered as a routine before hip fracture surgery since the results of these tests have little impact on the perioperative management [25]. …”

“…Routine preoperative spirometry plays very little or no role in patients with hip fracture [25]. The predictive value of spirometry for PPCs is not better than those of clinical findings such as history and physical examination [69, 70].…”