Preoperative Smoking Habits and Postoperative Pulmonary Complications

The association between preoperative smoking cessation and postoperative pulmonary morbidity was studied prospectively in 200 consecutive patients undergoing an elective coronary artery bypass surgical procedure. Detailed respiratory, cardiovascular, and smoking histories were elicited. Preoperative arterial blood gas analyses and bedside spirometry were performed. Urinary cotinine levels were measured to verify smoking histories. During spirometry, severe angina developed in seven patients, who were hence excluded from the study; one patient died of hemorrhage intraoperatively. An observer unaware of patients' preoperative histories assessed the remaining 192 patients throughout the intraoperative and postoperative periods for pulmonary complications. Postoperative pulmonary complications occurred in a third of the current smokers. Patients who had stopped smoking for 2 months or less had a pulmonary complication rate almost 4 times that of patients who had stopped for more than 2 months (57.1% versus 14.5%). Patients who had stopped smoking for more than 6 months had rates similar to those who had never smoked (11.1% and 11.9%, respectively). Preoperative pulmonary dysfunction, increased pack-years of smoking, prolonged surgical time, and the use of enflurane were independently associated with postoperative pulmonary morbidity (P less than 0.05). We concluded that smoking cessation should occur at least 2 months preoperatively to maximize the reduction of postoperative respiratory complications.

Role of Preoperative Cessation of Smoking and Other Factors in Postoperative Pulmonary Complications: A Blinded Prospective Study of Coronary Artery Bypass Patients

Upper abdominal surgery is associated with characteristic changes in pulmonary function which increase the risk of lower lobe atelectasis. Sixteen patients undergoing open cholecystectomy and 20 patients undergoing laparoscopic cholecystectomy were prospectively evaluated by pulmonary function tests (forced vital capacity [FVC], forced expiratory volume [FEV-1], and forced expiratory flow [FEF] 25% to 75%) before operation and on the morning after surgery to determine if the laparoscopic technique lessens the pulmonary risk. Fraction of the baseline pulmonary function was calculated by dividing the postoperative pulmonary function by the preoperative pulmonary function and multiplying by 100%. Postoperative FVC measured 52% of preoperative function for open cholecystectomy and 73% for laparoscopic cholecystectomy (p = 0.002). Postoperative FEV-1 measured 53% of baseline function for open cholecystectomy and 72% for laparoscopic cholecystectomy (p = 0.006). Postoperative FEF 25% to 75% measured 53% for open cholecystectomy and 81% for laparoscopic cholecystectomy (p = 0.07). It is concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique.

Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function.

https://journal.chestnet.org/article/S0012-3692(16)61719-1/pdf

Preoperative pulmonary function testing to predict postoperative morbidity and mortality

Although severe impairment on routine pulmonary function tests will identify patients with a high post-thoracotomy morbidity, cardiopulmonary complications often develop in patients with only a mild-to-moderate impairment in pulmonary function. To determine whether the preoperative exercise capacity can prospectively identify those at risk of developing complications, 22 patients scheduled for thoracotomy (mean age, 55.7 ± 2 yr) underwent an incremental exercise test on a cycle ergometer to determine their maximal O2 uptake prior to thoracotomy. Routine pulmonary function tests were performed and postoperative forced expiratory volume in one second (FEV1) was predicted from split function perfusion lung scan in all subjects. Eleven of the 22 patients had no cardiopulmonary complications postoperatively. The age, history of prior cardiovascular disease, degree of impairment on routine pulmonary function tests, and predicted postoperative FEV1 were similar in those who did and those who did not experience c...

Exercise capacity as a predictor of post-thoracotomy morbidity

Preoperative and postoperative measurements of the FVC, FEV1, pCO2, O2 saturation, and pH were taken in forty-six patients having elective upper abdominal surgery. Postoperatively, the FVC and FEV1 were reduced by 65 per cent and all patients demonstrated hypoxemia. A significant difference existed in the FVC and FEV1 of the “normal” subjects versus those subjects in whom macroatelectasis developed. Impairment seen on preoperative pulmonary function studies, obesity, smoking, and prolonged anesthesia time increased postoperative pulmonary complications.

Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis

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Ventilatory patterns and pulmonary complications after upper abdominal surgery determined by preoperative and postoperative computerized spirometry and blood gas analysis