Patient assessment and prevention of pulmonary side-effects in surgery

The review deals with the clinical and functional assessment that is requested before surgical operations and with the pulmonary effects of surgery. Moreover, an evidence-based approach to prevent postoperative pulmonary complications is provided.

Spirometry is recommended for patients with a history of tobacco use or dyspnoea who are considered for cardiac or upper abdominal surgery and for all patients who are candidates for lung resection. For patients undergoing lung resection, low complication rates have been associated with a preoperative forced expiratory volume at first second value of at least 2 litres or 80% of the predicted value and at least 1.5 litres or 60% of the predicted value in the case of pneumonectomy or lobectomy, respectively. At-risk patients are recommended to undergo split lung function studies to estimate the residual parenchyma function after surgery. In patients with borderline estimated values, a cardiopulmonary exercise test is recommended to stratify further risk. Preventive interventions of postoperative pulmonary complications, including pain control, respiratory chest physiotherapy and continuous positive airway pressure may effectively reduce the occurrence of pulmonary complications.

Pulmonary functional assessment is relevant in patients candidates for surgery. The prevention of the postoperative pulmonary complications is one of the most important goals of the treatment of patients undergoing surgery.