Patients at risk for OSA should be asked the following four questions: 1. Snore: Do you snore loudly?   2. Tired: Do you often feel tired, fatigued, or sleepy during the day?   3. Observed: Has anyone observed you stop breathing during your sleep?   4. Blood pressure: Do you have or are you being treated for hypertension?   If a patient answers yes for two or more questions, he or she is at high risk for OSA. Continuous positive airway pressure (CPAP), the mainstay treatment for OSA, may be considered during the

perioperative period, and elective polysomnography should be arranged later on [64]. For those with known OSA prior to hip fracture, adequate treatment, such as CPAP, mandibular advancement device, or oral appliances, should be provided as recommended by the guidelines from the American Society of Anaesthesiologists [62]. Other chronic lung diseases Although other chronic lung diseases such as this website interstitial lung disease, neuromuscular disease, chest wall deformity, or pulmonary artery hypertension may increase the risk of PPCs after lung resection and other non-cardiothoracic surgery [65, 66], there is no strong evidence suggesting an increased risk for pulmonary complications after hip fracture surgery among patients with these conditions [25]. Preoperative tests Preoperative tests such

as chest radiograph, spirometry, or arterial blood gas should not be ordered as a routine PD98059 cost before hip fracture surgery since the results of these tests have little impact on the perioperative management [25]. Chest radiograph selleck Routine chest radiograph should not be done for patients with hip fracture. A

meta-analysis of studies involving 14,390 preoperative chest radiographs C59 cell line found that only 14 cases with chest radiographs were unexpectedly abnormal and management was changed [67]. Another study demonstrated that, despite a lower rate of PPCs in patients who received preoperative chest radiograph (12.8% vs 16%), only 1–4% of the patients’ managements were altered due to the result of chest radiograph [68]. Chest radiograph is only indicated in: (1) patients with unexplained respiratory symptoms or (2) suspected lower respiratory tract infection based on clinical findings. Spirometry and arterial blood gas Routine preoperative spirometry plays very little or no role in patients with hip fracture [25]. The predictive value of spirometry for PPCs is not better than those of clinical findings such as history and physical examination [69, 70]. Guidelines recommend that preoperative spirometry is indicated in patients with unexplained respiratory symptoms before undergoing orthopedic surgery [44]. Spirometry is also helpful in determining whether patients with COPD or asthma are under optimal control before surgery. Early studies indicated that a partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mm Hg increases the risk of PPCs [71, 72].