The high incidence of postoperative complications in patients with idiopathic pulmonary fibrosis (IPF) poses a significant barrier to safe perioperative care of patients, according to a new review.

“Ensuring that the preoperative IPF patient has been medically optimized is important for minimizing this risk,” said the authors of the study published in the International Journal of General Medicine.

Several diseases and conditions, such as cardiovascular and lung diseases, are known to have a negative impact on patients’ survival. Hence, the authors recommend prioritizing the identification and treatment of comorbid conditions during the preoperative assessment of patients with IPF. For instance, preoperative smoking cessation should be encouraged and patients should be screened for obstructive sleep apnea.


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They also suggested that its essential to identify patients with IPF at high perioperative pulmonary risk, in particular those with 6 to 12-month declines in the diffusion capacity for carbon monoxide >15%, maximal oxygen consumption <8.3 mL/kg/min, predicted value for the forced vital capacity <80%, 50-meter reduction in the 6-Minute Walk Test, or preoperative home oxygen use.

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The Assess Respiratory Risk in Surgical Patients in Catalonia score, cardiopulmonary exercise testing, and pulmonary function examination are methods to help in risk stratification of patients with IPF. Moreover, the use of biomarkers such as serum lactate dehydrogenase, albumin, and prealbumin could be considered.

General endotracheal anesthesia and prolonged mechanical ventilation can lead to an exacerbated inflammatory response in patients with IPF. Therefore, the authors recommend minimizing excessive oxygen fractions and to use regional or neuraxial anesthesia instead of general anesthesia when indicated.

Acute exacerbation, pneumonia, pulmonary infections, and persistent pneumothorax have been identified as important postsurgical complications in patients with IPF, so patients should be maintained in close surveillance to ensure early treatment, the authors said.

Restrictive perioperative fluid management strategies could help reduce the postoperative burden of acute exacerbation, while noninvasive positive pressure ventilation might help reduce the risk of postoperative reintubation in patients with hypoxemia.

Reference

Carr ZJ, Yan L, Chavez-Duarte J, Zafar J, Oprea A. Perioperative management of patients with idiopathic pulmonary fibrosis undergoing noncardiac surgery: a narrative review. Int J Gen Med. 2022;15:2087-2100. doi:10.2147/IJGM.S266217