The American College of Physicians have identified risk factors associated with perioperative pulmonary complications in patients undergoing noncardiothoracic surgery. These can help identify a patient who may benefit from more aggressive management before, during and after surgery.
Significant risk factors for pulmonary complications:
(1) chronic obstructive pulmonary disease (COPD), including severe asthma
(2) age > 60 years
(3) ASA class II to V
(4) functional dependency prior to surgery
(5) congestive heart failure
(6) serum albumin < 3.5 g/dL
Procedures associated with a higher risk of pulmonary complications:
(1) prolonged surgery (lasting more than 3 hours)
(2) abdominal surgery
(3) thoracic surgery
(4) neurosurgery
(5) head and neck surgery
(6) vascular surgery
(7) repair of aortic aneurysm
(8) emergency surgery
(9) use of general anesthesia
where:
• It appears that thoracic surgery is not considered as cardiothoracic.
Ways of reducing pulmonary complications in a high risk patient:
(1) deep breathing exercises prior to surgery
(2) incentive spirometry before and after surgery
(3) selective use of a nasogastric tube to reduce aspiration
(4) discontinuation of cigarette smoking well in advance of surgery
(5) nutritional support for those who are malnourished
