Identifying and reducing risks of postoperative pulmonary complications
Aaron Sigona, Deborah C. Richman
Abstract
: Postoperative pulmonary complications (PPCs) are a significant cause of morbidity and mortality following surgery and anesthesia. This article aims to explore the etiology, risk factors, and prevention strategies associated with PPCs. PPCs encompass a wide spectrum of respiratory complications, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis. Multiple patient-related and surgical-related risk factors contribute to the development of PPCs, such as pre-existing lung disease, smoking history, advanced age, prolonged anesthesia, and surgical site. Several preventive measures throughout the preoperative to postoperative periods have been proposed to minimize the incidence and severity of PPCs. The preoperative evaluation should have a coordinated approach that integrates risk assessment tools to provide personalized care to the patients’ specific risk profile. Preoperative optimization of lung function through smoking cessation, respiratory muscle training, and bronchodilator therapy can attenuate the risk. Intraoperative lung-protective ventilation strategies, including low tidal volume ventilation, positive end-expiratory pressure (PEEP), and recruitment maneuvers have shown promising results. Early mobilization, incentive spirometry, and pulmonary rehabilitation programs in the postoperative period also play a significant role in preventing complications. PPCs pose a considerable challenge in the perioperative period. Understanding the multifactorial etiology and implementing appropriate preventive strategies can reduce the burden of these complications, improve patient outcomes, and enhance overall surgical care.