Preoperative Pulmonary Risk Stratification

1. See Also
   1. Preoperative Examination
   2. Preoperative Cardiovascular Evaluation
   3. Preoperative Evaluation in Kidney Disease
   4. Perioperative Beta Blocker
   5. Antiplatelet Therapy for Vascular Disease
   6. Perioperative Cardiovascular Risk
   7. Perioperative Diabetes Management
   8. Deep Vein Thrombosis Prevention
   9. Perioperative Anticoagulation
   10. Endocarditis Prophylaxis
   11. Postoperative Nausea and Vomiting Prevention
   12. Perioperative Corticosteroid
   13. Preoperative Guidelines for Medications Prior to Surgery
2. Indications
   1. Informed Consent regarding pulmonary surgical risk for elective non-cardiac surgery
      1. Review with patient if benefits of procedure outweigh risks
3. 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
4. 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
5. 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]
6. 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]