title: Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery.
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 < or = 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.
authors.affiliation: Division of General Internal Medicine, University of Alberta, Edmonton, Canada. finlay.mcalister@ualberta.ca
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Papaioakim
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Fisher
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Malcolm
authors.initials: M
authors.lastname: Daniel
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000150:complications; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010808:Physical Examination; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects