Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery

Introduction Postoperative pulmonary complications (PPCs) are as common as cardiac complications following non-cardiothoracic surgery and carry significant morbidity and mortality [1]. The incidence of PPCs was higher than cardiac complications (2.7% vs 2.5%) in the cohort of non-cardiac surgical patients used to validate the Revised Cardiac Risk Index [2]. An earlier study of patients undergoing abdominal surgery revealed not only similar results but also longer hospital stays [3]. More recently, Lawrence et al. in a large retrospective cohort study of patients undergoing hip repair showed that serious pulmonary and cardiac complications have similar incidence and significant impact on mortality and length of stay [4]. Postoperative pulmonary complications are a marker of poor prognosis. In patients with or without respiratory failure following vascular and general surgical procedures, mortality at 30 days in the respiratory failure group was 26.5% compared with 1.4% in those without it [5]. Similarly, a prospective study of patients age ≥ 70 years examined predictors of mortality up to 3 years following non-cardiac surgery. Postoperative pulmonary complications were independent predictors of decreased long-term survival [6]. These findings confirm the clinical importance of PPCs.