Managing Postoperative Pulmonary Complications

There has been increased focus on the need for higher-quality, safer, and more appropriate care in hospitals nationwide. One of the most important components of this mission is to reduce the risk of complications after surgery. Postoperative pulmonary complications (PPCs) are considered modifiable adverse clinical events. Anticipating and preventing these problems have become key measures of the quality and safety of hospital care in the United States. “PPCs are a major contributor to the overall risk in many types of surgery and have been associated with considerable morbidity and mortality,” says Aryeh Shander, MD, FCCP, FCCM. “Despite this, awareness of the consequences and prevention of PPCs remain relatively low.” In 2009, 15 experts in the fields of surgery, anesthesiology or critical care, internal and hospital medicine, and health services with experience in managing PPCs were convened in a patient safety summit. This resulted in a paper published in the September 2011 issue of Critical Care Medicine. Dr. Shander, lead author of the paper, says “we wanted to enhance and increase physician awareness of PPCs, recommend strategies to reduce the impact of these complications, provide information to catch patients at increased risk, and identify patients who would benefit from preventive interventions and more intensive monitoring.” Defining Pulmonary Complications PPCs are broadly defined as conditions affecting the respiratory tract that can adversely influence the clinical course of patients after surgery. “PPCs have a multifactorial etiology and are associated with many preoperative, intraoperative, and postoperative risk factors,” explains Dr. Shander. “Several independent risk factors for PPCs have been identified [Table 1], but more research is needed in this area. Increasing awareness and...