In and Out - preoperative pulmonary assessment
Postoperative complications are a major contributor to morbidity, mortality, and increased financial burden on patients and healthcare. So it makes sense that we do as much as we can to prevent adverse outcomes for our patients.
🔸 Of significant concern are postoperative pulmonary complications (PPCs) — but with solid preoperative assessment of risk factors and implementation of evidence-based preventative strategies, we can drastically reduce their likelihood. Here’s what you need to know:
🔹 Risk factors:
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Patient factors such as advanced age, higher ASA scores, and pre-existing conditions like COPD or OSA
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Surgeries involving the thoracic or upper abdominal cavities (closer to the diaphragm = higher risk)
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General anaesthesia and prolonged surgical time
🔹 Preventive strategies:
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Thorough preoperative evaluation of respiratory function and overall health 🩺
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Smoking cessation preoperatively (ideally 4–8 weeks — but anything helps!) 🚭
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Respiratory prehab and education to improve lung capacity and function before surgery
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Strategies to reduce surgical duration wherever possible
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Utilising regional anaesthesia to reduce postoperative opioid requirements
Perioperative nurses play an integral role in these preventive measures — from educating patients and monitoring for early signs of respiratory distress, to ensuring protocols are followed and standards of care are maintained.
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References:
Brunelli, A., Kim, A. W., Berger, K. I., & Addrizzo-Harris, D. J. (2013). Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 143(5 Suppl), e166S–e190S. https://doi.org/10.1378/chest.12-2395
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