Wong et al identified risk factors for pulmonary complications after noncardiothoracic surgery in a patient with severe chronic obstructive pulmonary disease (COPD). These can help identify a patient who may require more aggressive management or who may a candidate for nonsurgical therapy. The authors are from the University of California at Irvine and the Long Beach Department of Veteran's Affairs.

Criteria for severe chronic obstructive pulmonary disease:

(1) FEV1 <= 1.2 liters

(2) ratio of FEV1 to FVC < 0.75


Type of surgery: noncardiothoracic


Risk factors associated with pulmonary complications (Table 3, page 281):

(1) Shapiro score >= 5 (out of 7, see previous section; death and bronchospasm)

(2) emergency surgery (death, pneumonia)

(3) FEV1 <= 0.75 liters (death) or <= 0.6 liters (prolonged ICU stay)

(4) ASA physical status IV or V (see Chapter 31; prolonged intubation)

(5) general anesthesia (bronchospasm, prolonged ICU stay)

(6) anesthesia duration > 6.5 hours (prolonged ICU stay; risk for pulmonary complications low if < 2 hours; I will use >= 3 hours in the implementation)

(7) abdominal incision (prolonged ICU stay)


Options for managing at patient at high risk for postoperative pulmonary complications:

(1) Not perform the surgery.

(2) Avoid general anesthesia and tracheal intubation.

(3) Shorten the duration of the surgical procedure.

(4) Avoid an abdominal incision if possible.

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