In an effort to contain the expense of respiratory therapy modalities as well as to provide the level of respiratory care most appropriate for postoperative patients, we devised a perioperative respiratory therapy program (PORT). We describe the response of 1,476 consecutive patients treated by our Respiratory Care Department prior to and during the first year of PORT. Surgical procedures were divided into ten categories. The PORT group had significantly lower cost than the non-PORT group in two of the categories, with a significantly higher cost in one. We describe the advantages of PORT, which were identified by participating surgeons, respiratory therapists, and patients. We present a simple, bedside, risk assessment form which enabled us to predict the risk of postoperative pulmonary complications and to provide more aggressive respiratory therapy interventions to higher-risk patients.