Predictive determinants of preoperative functional status on the development of postoperative pulmonary complications in patients after thoracic and abdominal surgery: a systematic review
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Background and purpose The incidence of postoperative pulmonary complications is high, especially in patients undergoing thoracic and (upper) abdominal surgery and postoperative complications within this group are associated with substantial mortality and morbidity. The need for a clinically appropriate test or instrument(s) to successfully identify those who are at risk in developing PPC or predisposing for a prolonged hospital-stay has been emphasized for a long time The main objective of this study is to identify predictive determinants of a patient’s functional status on the development of postoperative pulmonary complications after thoracic and (upper) abdominal surgery. Methods A systematic literature search in the electronical databases MEDLINE, Embase, The Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials and CINAHL until December 2008 was performed. Only prospective studies on patients undergoing thoracic (non-cardiac) or abdominal surgery were included. Results Thirty-two studies met our criteria for inclusion and were reviewed by two independent assessors. Most predictive factors were related to exercise capacity. Patients maximal oxygen uptake (VO2max) expressed in ml.kg-1.min-1, or as percentage of predicted, and height climbed on stairs are the strongest predictors of the development of PPC. Conclusion Our results suggest, that physical components of a patient’s preoperative functional status is predictive for the development of PPC in lung surgery. Exercise capacity, expressed as VO2max, has the best predictive ability. Other exercise tests, e.g. stair climbing can be very useful as a first stage screening test. Clinical relevant cut points are presented and can reinforce current guidelines on clinical decision making in patients undergoing lung surgery.