Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
11 - Postoperative pulmonary complications
Published online by Cambridge University Press: 12 January 2010
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
Summary
Postoperative pulmonary complications are defined as pulmonary abnormalities occurring in the postoperative period that produce clinically significant identifiable disease or dysfunction that adversely affect the clinical course. The incidence of these complications ranges from 2 to 100% in various series, depending on predisposing risk factors as well as the specific surgical procedure (Table 11.1). Taken together, they are more common than postoperative cardiac complications, lead to longer hospital stays (22.7 vs. 10.4d), and increase the relative risk of death to 14.9 (95% confidence limits 4.76–26.9), particularly due to pneumonia.
Factors associated with an increased risk for postoperative pulmonary complications include the following:
surgical site
prolonged duration of surgery
underlying lung disease
smoking history (> 20 pack years)
obesity (BMI > 25)
poor nutritional status
age > 60 years
ASA > 3
inadequate nurse staffing in postoperative care areas.
Patients should be evaluated preoperatively to identify these factors and efforts made to improve risk status. Preoperative respiratory assessment and management are discussed elsewhere.
The pathogenesis of pulmonary complications in the postoperative period has been well described. Hypoventilation and reduced lung volumes beginning with anesthesia and surgery combine to produce atelectasis and predispose to respiratory tract infection. Immobility leads to higher risk of thromboembolic disease. Respiratory muscle dysfunction is common, especially following cardiac, chest, or upper abdominal operations. Cardiac surgeries are associated with a 10%–85% incidence of phrenic nerve dysfunction due to phrenic nerve injury, either by cold injury or by direct operative damage.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 158 - 178Publisher: Cambridge University PressPrint publication year: 2006