Everything should be made as simple as possible, but not simpler.

The assessment of preoperative risk, because of its inherent complexity, should bring to mind the previous quote. Today the practicing clinician has many tools available to risk stratify medically complicated patients. These tools should assist the clinician to (1) improve patient outcomes, (2) plan health care resource allocation, and (3) optimize the economics of health care delivery.

The physician involved in the management of patients undergoing surgery needs to be aware that postoperative pulmonary complications are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care.<sup>26 Lawrence V.A., Hilsenbeck S.G., Mulrow C.D. , e al. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery J Gen Int Med 1995 ;  10 : 671-678  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Pneumonia, bronchitis, lobar atelectasis, respiratory failure, and prolonged mechanical ventilation are among the major pulmonary complications. The prevalence of these complications depends on a variety of risk factors, which may be divided broadly into patient-related and procedure-related factors.<sup>37 Smetana G.W. Preoperative pulmonary evaluation N Engl J Med 1999 ;  340 : 937-944  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Strategies aimed at preventing postoperative complications have the potential to decrease morbidity and mortality and improve resource use. Pulmonary risk indices, pulmonary function testing, cardiopulmonary exercise testing, and stair climbing all have been used to assign preoperative risk in patients undergoing elective surgery.<sup>13 Epstein S.K., Faling J., Daly B.D. , e al. Predicting complications after pulmonary resection: Preoperative exercise testing vs. a multifactorial cardiopulmonary risk index Chest 1993 ;  104 : 694-700  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 20 Holden D.A., Rice T.W., Stelmach K. , e al. Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection Chest 1992 ;  102 : 1774-1779  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 32 Olsen G.N., Bolton J.W.R., Weiman D.S. , e al. Stair climbing as an exercise test to predict the postoperative complications of lung resection—two years experience Chest 1991 ;  99 : 587-590  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Identification of high-risk patients preoperatively offers the advantage of increased attention to preoperative preparation with the ultimate goal of decreasing the incidence of postoperative pulmonary complications. This article reviews patient-related and procedure-related risk factors for the development of pulmonary complications. A case is presented to illustrate the occurrence of postoperative pulmonary complications in a medically complex but not uncommon high-risk patient. After a brief discussion of the case, the use of cardiopulmonary exercise testing and symptom-limited stair climbing as predictors of operative risk is reviewed. Strategies aimed at preventing the development of postoperative pulmonary complications through perioperative management are discussed.