Preoperative pulmonary evaluation: facts and myths

Area of Science:

• Pulmonary Medicine
• Surgical Oncology
• Critical Care Medicine

Background:

• Preoperative pulmonary evaluation is crucial for assessing surgical risk.
• Traditional pulmonary function tests (PFTs) are widely used but their predictive value for perioperative complications is debated.
• Thoracic and non-thoracic surgeries carry varying degrees of pulmonary risk.

Purpose of the Study:

• To review recent literature on preoperative pulmonary evaluation.
• To assess the impact of current evaluation methods on surgical outcomes.
• To propose an updated approach for managing patients with compromised pulmonary function.

Main Methods:

• Literature review of recent reports on preoperative pulmonary evaluation.
• Analysis of data linking pulmonary function tests to perioperative complications.
• Synthesis of evidence regarding the utility of lung function parameters in surgical decision-making.

Main Results:

• Existing pulmonary function tests show limited ability to predict perioperative complications.
• Lung function parameters alone are insufficient for determining surgical operability.
• The concept of 'prohibitive' lung function parameters for denying surgery is challenged.

Conclusions:

• Relying solely on PFTs for surgical decision-making is not recommended.
• A comprehensive, clinically oriented, and interdisciplinary approach is superior for evaluating high-risk surgical patients.
• Individualized patient assessment is key for optimizing outcomes in thoracic and non-thoracic surgery.