Preoperative Pulmonary Risk Stratification

Aka: Preoperative Pulmonary Risk Stratification, Perioperative Pulmonary Complication Risk Factors, Postoperative Pulmonary Complication Risk Assessment, NSQIP Pneumonia Risk Tool, NSQIP Respiratory Failure Risk Tool, Respiratory Failure Risk Index, ARISCAT Score for Postoperative Pulmonary Complications

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II. Indications

  1. Informed Consent regarding pulmonary surgical risk for elective non-cardiac surgery
    1. Review with patient if benefits of procedure outweigh risks

III. Risk Factors: Perioperative Pulmonary Complication Risk Factors by Patient Factors (Odds Ratio)

  1. Current Smoking: 1.4
  2. American College of Anesthesiologists (ASA) Class II or higher: 4.87
  3. Congestive Heart Failure: 2.93
  4. Chronic Obstructive Pulmonary Disease (COPD): 2.3
  5. Age over 60 years old: >2.28
  6. Unable to complete Activities of Daily Living (ADLs) without assistance or Assistive Devices: >1.65
  7. Serum Albumin <3.5 mg/dl

IV. Risk Factors: Perioperative Pulmonary Complication Risk Factors by Surgery (Odds Ratio)

  1. Aortic aneurysm repair: 6.9
  2. Thoracic Surgery: 4.24
  3. Abdominal surgery: 3.09
  4. Neurosurgery: 2.53
  5. Emergency surgery: 2.52
  6. General Anesthesia: 2.35
  7. Prolonged surgery >3 hours: 2.26
  8. Head and neck surgery: 2.21
  9. Vascular surgery: 2.10

V. Evaluation: Tools

  1. NSQIP Pneumonia Risk Tool
    1. https://www.mdcalc.com/gupta-postoperative-pneumonia-risk
    2. Predicts Pneumonia risk within 30 days following surgery
    3. Gupta (2011) Chest 140(5): 1207-5 [PubMed]
  2. NSQIP Respiratory Failure Risk Tool
    1. https://www.mdcalc.com/gupta-postoperative-respiratory-failure-risk
    2. Predicts Respiratory Failure within 30 days following surgery
    3. Gupta (2013) Mayo Clin Proc 88(11): 1241-9 [PubMed]
  3. Respiratory Failure Risk Index
    1. https://qxmd.com/calculate/calculator_261/postoperative-respiratory-failure-risk-calculator
    2. Based on male VA patients
    3. Arozullah (2000) Ann Surg 232(2): 242–3 +PMID:10903604 [PubMed]
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421137/
  4. ARISCAT Score for Postoperative Pulmonary Complications
    1. https://www.mdcalc.com/ariscat-score-postoperative-pulmonary-complications#evidence
    2. Canet (2010) Anesthesiology 113(6):1338-50 +PMID:21045639 [PubMed]

VI. References

  1. Dummer (2009) Perioperative Guideline Review
  2. Azharuddin (2019) Am Fam Physician 100(8): 499-501 [PubMed]
  3. Smetana (2006) Ann Intern Med 144(8):581-95 [PubMed]

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