Chow et al listed risk factors associated with postoperative pulmonary complications. These can help to identify a patient who may benefit from more aggressive management. The authors are from the National Surgical Quality Improvement Program and American Geriatrics Society.


Patient selection: surgery patient


Features of the operative procedure:

(1) prolonged operative procedure (> 3 hours)

(2) emergency surgery

(3) general anesthesia

(4) perioperative transfusion

(5) residual neuromuscular blockade after the operation

(6) high risk surgical site (vascular, thoracic, upper abdominal, head and neck, neurological)


Factors that are patient-specific:

(1) older age (> 60 years)

(2) ASA Class II or higher

(3) functional dependence

(4) impaired sensorium (acutely confused, delirium, mental status change)

(5) preoperative sepsis

(6) recent weight loss (> 10% in past 6 months)

(7) serum albumin < 3.5 g/dL)

(8) renal dysfunction (serum creatinine > 1.5 mg/dL, BUN >= 21 mg/dL)


Cardiopulmonary factors:

(1) chronic obstructive pulmonary disease (COPD)

(2) current smoker

(3) pulmonary hypertension

(4) obstructive sleep apnea

(5) congestive heart failure (CHF)


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