RT Book, Section A1 Levin, William I. A1 Reilly, John J. A2 McKean, Sylvia C. A2 Ross, John J. A2 Dressler, Daniel D. A2 Brotman, Daniel J. A2 Ginsberg, Jeffrey S. SR Print(0) ID 56194942 T1 Chapter 56. Management of Postoperative Pulmonary Complications T2 Principles and Practice of Hospital Medicine YR 2012 FD 2012 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-160389-8 LK accessmedicine.mhmedical.com/content.aspx?aid=56194942 RD 2024/03/29 AB General internists practicing in the inpatient setting are frequently called upon to provide perioperative care to a broad spectrum of surgical patients, in either a consultative or a comanagement role. Although historically much emphasis has been placed on postoperative cardiac complications, postoperative pulmonary complications are known to occur with equal frequency. The Confederate general, Thomas “Stonewall” Jackson, wounded in the Battle of Chancellorsville in 1863, was perhaps the earliest recorded victim of a postoperative pulmonary complication, dying of pneumonia eight days after the successful amputation of his left arm. Postoperative pulmonary complications contribute significantly to morbidity, mortality, and healthcare costs. It is estimated that over 1 million patients undergoing nonthoracic surgery in the United States annually experience postoperative pulmonary complications. Pulmonary complications produce the highest attributable costs among common categories of postoperative complications and can result in a fivefold increase in the median cost of an operation. The presence of pulmonary complications after major surgery increased 30-day mortality from 2% to 22%, and 1-year mortality from 8.7% to 45.9% based on data from the National Surgical Quality Improvement Program (NSQIP). The most important postoperative pulmonary complications are atelectasis, pneumonia, respiratory failure, and exacerbation of underlying chronic lung disease, although earlier studies have also included transient and self-limited clinical findings. A general principle is that the closer the operative site is to the diaphragm, the higher the likelihood of postoperative pulmonary complications. Interventions to reduce the incidence of these complications depend on the aggressive application of preventive measures to high-risk patients. A recent systematic review characterized patient-related and procedure-related risk factors and provided evidence-based guidelines on preventive strategies.1 This chapter focuses on the pathogenesis, early recognition, and evidence-based treatment of common postoperative pulmonary complications.