McAlister et al identified risk factors associated with pulmonary complications in patients undergoing nonthoracic surgery. These can help identify patients who may require preoperative interventions to reduce the risk. The authors are from the University of Alberta, University of Calgary, University of Toronto, Democritus University of Thrace, Mayo Clinic, and Glasgow Royal Infirmary.
Postoperative pulmonary complications may include:
(1) respiratory failure
(2) pneumonia
(3) atelectasis
Parameters:
(1) age of the patient in years
(2) cigarette smoking history
(3) laryngeal height in cm
(4) body mass index
(5) duration of operation
(6) history of COPD
(7) exercise capacity
(8) cough test
(9) wheeze test
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years of age |
0 |
|
|
>= 65 years of age |
1 |
|
cigarette smoking history |
none or < 40 pack years |
0 |
|
|
>= 40 pack years |
1 |
|
laryngeal height in cm |
> 4 cm |
0 |
|
|
<= 4 cm |
1 |
|
body mass index |
|
0 |
|
|
|
1 |
|
duration of operation |
< 2.5 hours |
0 |
|
|
>= 2.5 hours |
1 |
|
history of COPD |
no |
0 |
|
|
yes |
1 |
|
exercise capacity |
> 2 blocks and > 1 flights of stairs |
0 |
|
|
<= 2 blocks or <= 1 flight of stairs |
1 |
|
cough test |
negative |
0 |
|
|
positive |
1 |
|
wheeze test |
negative |
0 |
|
|
positive |
1 |
where:
• The laryngeal height is the vertical distance in the midline from the sternal notch to the top of the thyroid cartilage at end-expiration.
• The person did not need to be a current smoker.
total number of risk factors =
= SUM(points for all 9 findings)
Interpretation:
• minimum score: 0
• maximum score: 9
• The authors did not find an increased risk with general anesthesia or after an upper abdominal incision.
For patients identified as being at risk, preoperative pulmonary function tests and arterial blood gases can help stratify the risk.
Findings associated with postoperative pulmonary complications:
(1) FEV1 < 1 liter per minute (odds ratio 8)
(2) FVC < 1.5 liters per minute (odds ratio 11)
(3) PaCO2 >= 45 mm Hg (odds ratio 61)
(4) PaO2 < 75 mm Hg (odds ratio 13)
(5) forced expiratory time >= 9 seconds (odds ratio 6)
Specialty: Pulmonology, Surgery, general
ICD-10: ,
