O9.4 Pre-operative work-up surgery
Patients with COPD are at increased risk of post-operative pulmonary complications after any thoracic or non-thoracic surgery. A US database analysis has shown that COPD is associated with increased post-operative mortality and morbidity with major surgical procedures (Gupta 2013), including abdominal operations (Fields 2016). Careful pre-operative work-up of patients with COPD minimises post-operative complications. As no specific thresholds of lung function are mandated for non-thoracic surgery, the risk/benefit ratio for individual patients needs to be estimated for elective and urgent surgery. For lung resection to treat lung cancer, spirometry and diffusing capacity should be measured to estimate predicted post-operative lung function, and if required, exercise tests should be performed (Brunelli 2013).
COPD management should be optimised in the pre-operative period, including smoking cessation, inhaled bronchodilators and pulmonary rehabilitation. Specific peri- and post-operative management strategies have been suggested for patients with severe COPD. These strategies include early mobilisation and, where appropriate, minimising medications leading to respiratory depression, regional anaesthesia and controlled oxygen delivery in the post-operative period (Diaz-Fuentes 2016, Lakshminarasimhachar 2016).< Prev Next >