Preoperative assessment of the thoracic surgery patient: pulmonary function testing

Tests of pulmonary function before thoracic surgery can help to assess the risk of perioperative morbidity and mortality, and are the basis for estimating remaining lung function after resection of lung tissue. Testing has evolved over the past 50 years from reliance on the maximum breathing capacity to a range of studies including spirometry, and measurement of lung volume, diffusing capacity, and arterial blood gases, and the interpretation of these in conjunction with radionuclide scanning. The surgeon must consider both the early postoperative decrement in function and the level to which the patient is expected to recover. Although it is difficult to establish absolute limiting values, and current surgical techniques are blurring the boundary further, the reported experience underlying current guidelines is reviewed.