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Evaluation of preoperative pulmonary risk

Gerald W Smetana, MD
Section Editors
Talmadge E King, Jr, MD
Andrew D Auerbach, MD, MPH
Natalie F Holt, MD, MPH
Deputy Editor
Helen Hollingsworth, MD


Postoperative pulmonary complications contribute significantly to overall perioperative morbidity and mortality. The National Surgical Quality Improvement Program (NSQIP) found that postoperative pulmonary complications occurred in 6 percent of 165,196 patients who underwent major abdominal surgery [1]. In a separate study, postoperative pulmonary complications were the most costly of major postoperative medical complications (including cardiac, thromboembolic, and infectious) and resulted in the longest length of stay [2]. As the impact of pulmonary complications following surgery has become increasingly apparent, estimation of their risk should be a standard element of all preoperative medical evaluations.

The definition of postoperative pulmonary complications, pertinent anesthetic physiology, identification of patient and procedure-related risk factors, and the role of preoperative pulmonary function testing and pulmonary risk indices will be reviewed here. Strategies for reducing postoperative pulmonary complications and the evaluation of candidates for lung resection surgery are discussed separately. (See "Strategies to reduce postoperative pulmonary complications in adults" and "Preoperative evaluation for lung resection".)


The reported frequency of postoperative pulmonary complications in the literature varies from 2 to 70 percent. This wide range is due in part to patient selection and procedure-related risk factors, although differing definitions for postoperative complications account for much of the variability and make comparison of reported incidences across different studies difficult.

The preferred definition is a postoperative pulmonary abnormality that produces identifiable disease or dysfunction that is clinically significant and adversely affects the clinical course [3]. This would include several major categories of clinically significant complications, including [4,5]:


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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2016.
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