Perioperative Strategies for Reduction of Postoperative Pulmonary Complications

Abstract Postoperative pulmonary complications, estimated at between 2.0% to 5.6% in the general surgical population and 20-70% for upper abdominal and thoracic surgeries, are a significant factor leading to poor patient outcomes. Efforts to decrease the incidence of postoperative pulmonary complications such as bronchospasm, atelectasis, exacerbations of underlying chronic lung conditions, infections (bronchitis and pneumonia), prolonged mechanical ventilation, and respiratory failure, begins with a detailed preoperative risk evaluation. There are several available preoperative tests to estimate risk of postoperative pulmonary complications. However, the value of some of these studies to estimate postoperative pulmonary complications remains controversial and is still debated. In this review, preoperative risk assessment of postoperative pulmonary complications is examined, along with preoperative pulmonary tests to estimate risk, intraoperative and procedure-associated risk factors for postoperative pulmonary complications, and perioperative strategies to decrease postoperative pulmonary complications. The importance of minimizing these events is reflected in the fact that nearly 25% of postoperative deaths occurring in the first week after surgery are associated with postoperative pulmonary complications. This review provides important information to help clinical anesthesiologists to recognize potential risks for pulmonary complications and allows strategies to create an appropriate perioperative plan for patients.