Chest
Volume 93, Issue 5, May 1988, Pages 946-951
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Clinical Investigations
Perioperative Respiratory Therapy (PORT): A Program of Preoperative Risk Assessment and Individualized Postoperative Care

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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.

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MATERIALS AND METHODS

In January 1984 the St. Luke's Regional Medical Center Respiratory Care Department initiated the PORT program. Meetings had previously been held with the Departments of Surgery and of Obstetrics and Gynecology, at which all surgeons in both departments had been informed of the PORT program and had been invited to participate. Each surgeon had completed an order form specifying instructions for respiratory therapy modalities for his patients. Each surgeon had the option of ordering PORT or

RESULTS

Between Oct 1, 1983, and Dec 31, 1984, 1,488 patients were treated by the St Lukes Respiratory Care Department The records of 12 patients (0.08 percent) could not be located, and have, therefore, been dropped from the analysis. The remaining 1,476 records were analyzed.

Total numbers of patients were 276 pre-PORT, 345 PORT, and 855 non-PORT (Table 2). The types of surgical procedures are as shown. Of the operations, 822 (55.7 percent) were gynecologic, while 654 operations (44.3 percent) were

DISCUSSION

Pulmonary complications are known to be the most frequent causes of postoperative morbidity and mortality. Multiple risk factors, such as age, history of smoking, or of preexisting lung diseases, degree of obesity, and location of the surgical procedure, are important. It is believed that postoperative interventions by respiratory therapists have decreased the occurrence of these problems. However, because of the expense incurred with respiratory therapy treatments, third-party payers have

ACKNOWLEDGMENT

The authors thank Lois Reno and Susan Eby for their secretarial assistance in the preparation of this manuscript

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