Evaluation and management of patients with pulmonary disease before thoracic and cardiovascular surgery

The risks of respiratory complications after thoracic and cardiovascular surgeries are particularly high for patients with chronic pulmonary disease and are associated with prolonged hospital stays and increased mortality. The primary goals of preoperative management are to identify risk factors and institute interventions likely to reduce subsequent postoperative pulmonary complications. Smoking, symptomatic obstructive lung disease, respiratory infection, obesity, and malnutrition are all potentially modifiable risk factors. Chest physiotherapy is indicated in all patients regardless of risk factor profile. Providing a thoughtfully designed, multifaceted course of preoperative care can result in a clinically significant reduction in postoperative morbidity and mortality, particularly if instituted well in advance of surgery.