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

Division of General Internal Medicine, University of Alberta, Edmonton; Division of General Internal Medicine, University of Calgary, Calgary, AB; Divisions of General Internal Medicine and Geriatrics, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; Department of Anesthesia, Glasgow Royal Infirmary, Scotland

Correspondence and requests for reprints should be addressed to Dr. Finlay A. McAlister, 2E3.24 WMC, University of Alberta Hospital, 8440 112 Street, Edmonton, AB, Canada T6G 2R7. E-mail: finlay.mcalister{at}ualberta.ca

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.

Key Words: complications, postoperative • clinical skills • pulmonary function tests

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