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Published ahead of print on December 4, 2002, doi:10.1164/rccm.200209-985BC

Am. J. Respir. Crit. Care Med., Volume 167, Number 5, March 2003, 741-744

A more recent version of this article appeared on March 1, 2003
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Submitted on September 5, 2002
Accepted on November 12, 2002

Accuracy of the preoperative assessment in predicting pulmonary risk after non-thoracic surgery

Finlay A McAlister1*, Nadia A Khan2, Sharon E Straus3, Miltiadis Papaioakim4, Bruce W Fisher1, Sumit R Majumdar1, Ognjen Gajic5, Malcolm Daniel6, George Tomlinson3, and Investigators The CARE-PREOP1

1 Medicine, University of Alberta, Edmonton, Alberta, Canada, 2 Medicine, University of Calgary, Calgary, Alberta, Canada, 3 Medicine, University of Toronto, Toronto, Ontario, Canada, 4 Medicine, Democritus University of Thrace, Alexandroupolis, Greece, 5 Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA, 6 Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom

* To whom correspondence should be addressed. 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 non-thoracic surgery. Outcomes were assessed by an independent investigator blinded to the preoperative data. There were 22 (8%) postoperative pulmonary complications. Statistically significant predictors of pulmonary complications (all p<=0.005) were: hypercapnea >= 45 mm Hg (Odds Ratio 61.0), Forced Vital Capacity < 1.5 L/min (Odds Ratio 11.1), maximal laryngeal height <= 4cm (Odds Ratio 6.9), forced expiratory time >= 9 seconds (Odds Ratio 5.7), smoking >= 40 pack-years (Odds Ratio 5.7), and body mass index >= 30 (Odds Ratio 4.1). Multiple regression analyses revealed 3 preoperative clinical factors independently associated with pulmonary complications: age >= 65 years (Odds Ratio 1.8, p=0.02), smoking >= 40 pack years (Odds Ratio 1.9, p=0.02), and maximum laryngeal height <= 4 cm (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 non-thoracic surgery.
Key words: postoperative pulmonary risk assessment




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