Can a patient be healthy but still be at high risk of postoperative pulmonary complications? Why?
The clinical history is the most important element of the preoperative pulmonary evaluation; more so than for cardiac risk evaluation. Patient and procedure-related risk factors are used to estimate the risk of postoperative pulmonary complications, with procedure-related risk factors imparting the greatest risk. The physical exam helps confirm the history and determine if the patient’s underlying lung disease is optimized. PFTs and chest xrays play a limited role in risk assessment.
- Assess pulmonary risk using validated risk calculators (R1, R2, R3)
- Perform preoperative pulmonary testing in appropriate patients (R2, R3)
Review cases 1 and 2 for this section of the module.
- 2006 ACP Guidelines pgs 576 – 578 (stop at “Strategies To Reduce Postoperative Pulmonary Complications)
- Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure
- Development and Validation of a Risk Calculator for Predicting Postoperative Pneumonia
- UpToDate chapter: Evaluation of Preoperative Pulmonary Risk
Videos: (total viewing time 21:38)
- Patient Related Risk Factors for Postop Pulmonary Complications (5:15)
- Procedure Related Risk Factors for Postop Pulmonary Complications (4:41)
- Prediction Rules for Postoperative Pulmonary Complications (6:36)
- Who needs to undergo preoperative pulmonary testing? (5:06)
Annotated PowerPoint Slides: (Note: To download the slides click “Save” at the top of the presentation. After downloading, click on “View” tab and view as “Notes Page”)