Preoperative Risk Stratification [.phrase]

.CCpreop_PulmRiskStratification

Smoking cessation and offered nicotine replacement/buproprion/welbutrin but patient unwilling at this time

- From a preoperative pulmonary risk stratification perspective:

    -Ariscat Score 47, 42% Risk of perioperative pulmonary complication

    -Arozullah Respiratory Failure Index, Class 3 (27 Points), 4.2% incidence of postoperative respiratory failure (mechanical ventilation for >48 hours)

    -Poor 6MWT (~70meters) and severe depressed FEV1 (50.6%) also confer higher risk of perioperative pulmonary complication

- Patient at an elevated risk for pulmonary complications peri-procedurally

- Would mitigate this risk with peri-operative bronchodilator therapy,

- Low threshold for corticosteroids in the event of peri-procedural bronchospasm

- Low threshold for post-operative NiPPV in the setting of post operative hypercapnia

- Mindfulness of dynamic hyperinflation while on ventilator in the setting of his severe airflow obstruction

- PSG and evaluation for CPAP, high pre-test probability of OSA

- This PSG will likely not be done in time for a procedure on the 23rd, but we are trying to schedule it urgently