Accuracy of the Preoperative Assessment in Predicting Pulmonary Risk after Nonthoracic Surgery

TLDR

The study evaluated how accurately preoperative assessment predicts postoperative pulmonary complications in 272 patients scheduled for non‑thoracic surgery. A prospective cohort of 272 patients was examined, with postoperative outcomes independently assessed by a blinded investigator. Eight percent of patients experienced pulmonary complications, with hypercapnea, low FVC, low laryngeal height, prolonged forced expiratory time, heavy smoking, and obesity being significant predictors, and age ≥ 65, heavy smoking, and low laryngeal height independently associated with risk.

Abstract

We examined the accuracy of preoperative assessment in predicting postoperative pulmonary risk in a prospective cohort of 272 consecutive patients referred for evaluation before nonthoracic surgery. Outcomes were assessed by an independent investigator who was blinded to the preoperative data. There were 22 (8%) postoperative pulmonary complications. Statistically significant predictors of pulmonary complications (all p ⩽ 0.005) were as follows: hypercapnea of 45 mm Hg or more (odds ratio, 61.0), a FVC of less than 1.5 L/minute (odds ratio, 11.1), a maximal laryngeal height of 4 cm or less (odds ratio, 6.9), a forced expiratory time of 9 seconds or more (odds ratio, 5.7), smoking of 40 pack-years or more (odds ratio, 5.7), and a body mass index of 30 or more (odds ratio, 4.1). Multiple regression analyses revealed three preoperative clinical factors that are independently associated with pulmonary complications: an age of 65 years or more (odds ratio, 1.8; p = 0.02), smoking of 40 pack-years or more (odds ratio, 1.9; p = 0.02), and maximum laryngeal height of 4 cm or less (odds ratio, 2.0; p = 0.007). Thus, preoperative factors can identify those patients referred to pulmonologists or internists who are at increased risk for pulmonary complications after nonthoracic surgery.