title: Predicting postoperative pulmonary complications: implications for outcomes and costs.
abstract: OBJECTIVE
  This review of progress toward reliable prediction of postoperative pulmonary complications (PPCs) discusses risk assessment against the background of patient management strategies, clinical outcomes, and cost of healthcare.
  
  
  RESULTS
  Among the variety of conditions grouped as PPCs are pneumonia, aspiration pneumonitis, respiratory failure, reintubation within 48 h, weaning failure, pleural effusion, atelectasis, bronchospasm, and pneumothorax. PPC incidence rates range from 2 to 40% depending on context. These events increase mortality, postoperative length of stay, ICU admissions, hospital readmissions, and costs. PPC-associated mortality varies, but can reach as high as 48% in some contexts. ICU admission rates are between 9.5 and 91% higher in patients with PPCs. The mean increase in PPC-related postoperative length of stay is approximately 8 days. The cost of surgery can be two-fold to 12-fold higher when PPCs develop. Strategies proposed to reduce the impact of modifiable risk factors include alcohol and smoking abstinence before surgery, shortening the duration of surgery, and physiotherapy and incentive spirometry techniques; however, little scientific evidence supports them at this time.
  
  
  CONCLUSIONS
  PPCs are associated with a higher incidence of life-threatening events and higher costs. Reliable PPC risk-stratification tools are essential for guiding clinical decision-making in the perioperative period. The care team can act on modifiable factors and optimize vigilance over nonmodifiable ones. It would be useful to focus resources on determining whether low-cost preemptive interventions improve outcomes satisfactorily or new strategies need to be developed.
authors.affiliation: aDepartment of Anesthesiology and Postoperative Care, Fundació Puigvert (IUNA) bDepartment of Anesthesiology and Postoperative Care, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Sabaté
authors.forename: Valentín
authors.initials: V
authors.lastname: Mazo
authors.forename: Jaume
authors.initials: J
authors.lastname: Canet
mesh_terms: D017048:Health Care Costs; D006801:Humans; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality; D008329:Managed Care Programs; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome