Wong et al identified risk factors for pulmonary complications after noncardiothoracic surgery in a patient with severe chronic obstructive pulmonary disease (COPD). These can help identify a patient who may require more aggressive management or who may a candidate for nonsurgical therapy. The authors are from the University of California at Irvine and the Long Beach Department of Veteran's Affairs.
Criteria for severe chronic obstructive pulmonary disease:
(1) FEV1 <= 1.2 liters
(2) ratio of FEV1 to FVC < 0.75
Type of surgery: noncardiothoracic
Risk factors associated with pulmonary complications (Table 3, page 281):
(1) Shapiro score >= 5 (out of 7, see previous section; death and bronchospasm)
(2) emergency surgery (death, pneumonia)
(3) FEV1 <= 0.75 liters (death) or <= 0.6 liters (prolonged ICU stay)
(4) ASA physical status IV or V (see Chapter 31; prolonged intubation)
(5) general anesthesia (bronchospasm, prolonged ICU stay)
(6) anesthesia duration > 6.5 hours (prolonged ICU stay; risk for pulmonary complications low if < 2 hours; I will use >= 3 hours in the implementation)
(7) abdominal incision (prolonged ICU stay)
Options for managing at patient at high risk for postoperative pulmonary complications:
(1) Not perform the surgery.
(2) Avoid general anesthesia and tracheal intubation.
(3) Shorten the duration of the surgical procedure.
(4) Avoid an abdominal incision if possible.
