Anesthesia for Open Pulmonary Resection: A Systems Approach

Abstract

Perioperative morbidity and mortality are common following lung resection, with most deaths (>75%) attributed to major adverse pulmonary events (MAPE; including pneumonia, acute lung injury [ALI], and acute respiratory distress syndrome [ARDS]). Perioperative risk can be managed by dividing risk into two broad categories: iatrogenic risk and patient-attributed risk. Clinical care pathways manage iatrogenic risk, while perioperative strategies that allow identification and optimal management of high-risk patients manage patient-attributed risk. These factors will improve outcomes and reduce hospital costs. Patient safety and the delivery of quality care, with emphasis on systems improvement, have emerged as central tasks for healthcare providers. In fact, benchmarking of data will increasingly allow patients to identify institutions that deliver on the value proposition - providing medical care that measures up in safety and quality and yet is delivered at significantly lower costs.