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Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies*

Shander, Aryeh MD, FCCP, FCCM; Fleisher, Lee A. MD; Barie, Philip S. MD, MBA, FIDSA, FACS, FCCM; Bigatello, Luca M. MD; Sladen, Robert N. MD; Watson, Charles B. MD

doi: 10.1097/CCM.0b013e31821f0522
Review Article

Objective: Postoperative pulmonary complications are a major contributor to the overall risk of surgery. We convened a patient safety summit to discuss ways to enhance physician awareness of postoperative pulmonary complications, advance postoperative pulmonary complications as a substantive public health concern demanding national attention, recommend strategies to reduce the deleterious impact of postoperative pulmonary complications on clinical outcomes and healthcare costs, and establish an algorithm that will help identify patients who are at increased risk for postoperative pulmonary complications.

Data Sources: We conducted PubMed searches for relevant literature on postoperative pulmonary complications in addition to using the summit participants' experience in the management of patients with postoperative pulmonary complications.

Data Synthesis: Postoperative pulmonary complications are common, are associated with increased morbidity and mortality, and adversely affect financial outcomes in health care. A multifaceted approach is necessary to reduce the incidence of postoperative pulmonary complications. Identifying a measurable marker of risk will facilitate the targeted implementation of risk-reduction strategies.

Conclusions: The most practicable marker that identifies patients at highest risk for postoperative pulmonary complications is the need for postoperative mechanical ventilation of a cumulative duration >48 hrs.

From Englewood Hospital and Medical Center (AS), Englewood, NJ; the University of Pennsylvania (LAF), Philadelphia, PA; Weill Cornell Medical College (PSB), New York, NY; VA Boston Healthcare System (LMB), West Roxbury, MA; College of Physicians and Surgeons of Columbia University (RNS), New York, NY; and Yale New Haven Health System (CBW), Bridgeport, CT.

Dr. Shander consulted for and received honoraria/speaking fees from Covidien. Dr. Bigatelllo consulted for Covidien. The remaining authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins