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



• 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

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