Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians
- Amir Qaseem, MD, PhD, MHA;
- Vincenza Snow, MD;
- Nick Fitterman, MD;
- E. Rodney Hornbake, MD;
- Valerie A. Lawrence, MD;
- Gerald W. Smetana, MD;
- Kevin Weiss, MD, MPH;
- Douglas K. Owens, MD, MS; and
- for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians*
- From the American College of Physicians, Philadelphia, Pennsylvania; North Shore Medical Group, Huntington, New York; University of Texas Health Science Center at San Antonio, San Antonio, Texas; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Hines VA Hospital and Northwestern University, Chicago, Illinois; and Palo Alto Health Care System and Stanford University, Stanford, California.
Abstract
Postoperative pulmonary complications play an important role in the risk for patients undergoing noncardiothoracic surgery. Postoperative pulmonary complications are as prevalent as cardiac complications and contribute similarly to morbidity, mortality, and length of stay. Pulmonary complications may even be more likely than cardiac complications to predict long-term mortality after surgery. The purpose of this guideline is to provide guidance to clinicians on clinical and laboratory predictors of perioperative pulmonary risk before noncardiothoracic surgery. It also evaluates strategies to reduce the perioperative pulmonary risk and focuses on atelectasis, pneumonia, and respiratory failure. The target audience for this guideline is general internists or other clinicians involved in perioperative management of surgical patients. The target patient population is all adult persons undergoing noncardiothoracic surgery.
*This paper, written by Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Nick Fitterman, MD; E. Rodney Hornbake, MD; Valerie A. Lawrence, MD; Gerald W. Smetana, MD; Kevin Weiss, MD, MPH; and Douglas K. Owens, MD, MS, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Douglas K. Owens, MD, MS (Chair); Mark Aronson, MD; Patricia Barry, MD, MPH; Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Nick Fitterman, MD; E. Rodney Hornbake, MD; Katherine D. Sherif, MD; and Kevin B. Weiss, MD, MPH (Immediate Past Chair). Approved by the ACP Board of Regents on 21 January 2006.
Article and Author Information
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Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.
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Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
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Grant Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget.
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Potential Financial Conflicts of Interest: Stock ownership or options (other than mutual funds): G.W. Smetana (SafeMed Harvard Imaging); Other: G.W. Smetana (Novartis Pharma Schweiz).
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Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem{at}acponline.org.
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Current Author Addresses: Drs. Qaseem and Snow: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
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Dr. Fitterman: 120 New York Avenue, Suite 3W, Huntington, NY 11743.
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Dr. Hornbake: 7 Shelter Rock Road, P.O. Box 218, Hadlyme, CT 06439.
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Dr. Lawrence: 7703 Floyd Curl Drive, Mail Code 7879, San Antonio, TX 78229.
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Dr. Smetana: Shapiro 621D, 330 Brookline Avenue, Boston, MA 02215.
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Dr. Weiss: P.O. Box 5000, Hines, IL 60141.
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Dr. Owens: 117 Encina Commons, Stanford, CA 94305.
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