Which preoperative respiratory evaluation?

Area of Science:

• Anesthesiology
• Pulmonology
• Critical Care Medicine

Background:

• Postoperative respiratory complications (PORC) affect 6.8% of all surgeries.
• Factors influencing PORC include surgical and anesthetic elements.
• PORC encompass conditions like atelectasis, pulmonary infections, and acute ventilatory distress.

Purpose of the Study:

• To evaluate the predictive value of preoperative assessments for PORC.
• To compare the utility of standard pulmonary function tests (PFTs) versus clinical scores for risk stratification.
• To identify optimal methods for assessing respiratory risk before surgery.

Main Methods:

• Validation of simple risk scores using anamnestic data, clinical examination, and biological parameters.
• Assessment of the utility of standard pulmonary function tests (PFTs).
• Consideration of specialized Explorations Fonctionnelles Respiratoires (EFR) for specific cases like lung reduction surgery.

Main Results:

• Standard PFTs have limited value in predicting individual PORC risk, often confirming clinical severity.
• Validated simple scores effectively assess PORC risk based on surgery type.
• Specialized EFR may be necessary for lung reduction surgeries to predict post-interventional outcomes.

Conclusions:

• Preoperative risk assessment using validated scores is crucial for predicting PORC.
• Clinical evaluation and specific scores are more valuable than standard PFTs for individual risk assessment.
• Tailored respiratory evaluations, including specialized tests when needed, optimize patient management and outcomes.