Perioperative Adverse Event (Pulmonary Complications): A Succinct overview

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Pulmonary complications remain a major cause of mortality, morbidity, increased cost of care and prolonged hospital stay. Preoperative pulmonary complications take the form of conditions such as pneumonia and atelectasis. A person with a pulmonary complication suffers from an identifiable disease or dysfunction that is of clinical relevance and which has an adverse effect on the clinical course.

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Pulmonary complications are a major health risk and are even more common than cardiac complications, according to recent studies. Other common pulmonary complications include brochospasm, prolonged mechanical ventilation, and exacerbation of a lung disease.

Pulmonary complications affect older people more adversely than they do health ones. Other people at risk of encountering these complications include smokers, obese people, asthma patients and people who are generally of poor health status.

Pulmonary complications may be brought about by both patient-related factors and procedure related factors. Patient-related risk factors include poor health, advanced age, nutritional and neurological, status, immune and fluid status, underlying chronic respiratory disease, emergency surgery and smoking.

Procedure-related risk factors for pulmonary complications are of more importance than patient-related factors when it comes to prediction of preoperative outcomes. The site of the surgery may imply an increased risk or a low risk of these complications. People who are undergoing thoracic or upper abdominal surgery face a decreased preoperative vital capacity. This capacity is always lower in thoracic and upper abdominal surgery compared to lower abdominal surgery. The most common pulmonary complications that occur after thoracic and upper abdominal surgery include pain and splinting, diaphragmatic dysfunction, atelectasis and pneumonia, impairment of mucociliary clearance, microaspiration and impaired gas exchange.

            The choice of anesthesia is another operation-related risk factor for pulmonary complications. When surgery is done in a supine position under anesthesia, alteration in lung volumes occurs. Additionally, mucociliary clearance mechanisms are impaired as well as other lung mechanics that relate to gaseous exchange. The duration of the anesthesia also has an effect on a postoperative outcome. Surgical operations that last for longer then 4 hours carry an increased pulmonary complication risk.

            It has also been noted that general anesthesia is associated with a higher risk of pulmonary complications that are clinically important, compared to spinal or epidural anesthesia. Moreover, risk factors associated with post-operative care include use of parenteral narcotics and nasogastric tube for the purpose of pain control.