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DO HISTORY, PHYSICAL, AND SPIROMETRY PREDICT PULMONARY COMPLICATIONS?

Departments of Anesthesiology and Medicine, University of Alberta Hospital, 3B2.32 Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, T6G 2B7

INTRODUCTION

Pulmonary complications are believed to be significant causes of postoperativc morbidity and mortality. The purpose of this study was to determine the elements of the history, physical examination and simple spirometry that predict of postoperative pulmonary complications.

METHODS

After obtaining ethics approval and informed consent, we studied 399 patients undergoing elective nonthoracic procedures in a tertiary-care teaching hospital, and anticipate accruing a total of 1200. Patients were assessed preoperatively during their visit to the pre-admission clinic. A focussed pulmonary history and physical exam were conducted along with simple spirometry. A history of smoking, recent upper respiratory tract infection, COPD, asthma, daily cough, or diminished exercise capacity, presence of wheezing on auscultation, elicited coughing spasm, forced expiratory time, maximum laryngeal descent and FEV1/FVC were recorded. The main outcome measures were death, respiratory failure requiring mechanical ventilation (including BIPAP), pneumonia, atelectasis, pneumothorax or pleural effusion, and delayed weaning from assisted ventilation.

RESULTS

Major pulmonary complications occurred in 2 (2%) of 99 patients who have completed follow-up. Both complications involved pneumonia which responded to antibiotics. A history of a daily cough was associated an increased likelihood of postoperative complications (p<0.01).

Variable Mean Variable Value Variable Value Age 54.3 y Asthma 14% FEV1 2.55 (.76) Female/Male 51/48 Cough History 11% FVC 3.38 (.92) Ever Smoked 64% Cough Test 5% FEV1/FVC 0.75 Still smoke 42% Recent URTI 13% LOS 4.99 days COPD 3% Postop Comp 2%

DISCUSSION

The incidence of risk factors for perioperative pulmonary complications has not been well documented. General attention to optimal patient condition at all times, particularly perioperatively, is prudent, but the patients at highest risk and therapeutic interventions of greatest benefit remain unknown. Consequently the need for deferral of elective surgery, institution of intensive care and modification of therapy are based on opinion more than objective data. This study suggests that the incidence of perioperative pulmonary complication may be lower than expected. A history of daily cough was more closely correlated with complications than other predictors. Follow-up of further patients in this study will add to the assessment of predictive value of the other components of history, physical, and spirometry.

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