Preoperative spirometry and perioperative drug therapy in patients with obstructive pulmonary dysfunction

The presence and severity of obstructive pulmonary diseases is important determinants of non-fatal and fatal postoperative complications. This study examined the characteristics of patients in need of perioperative drug therapy for obstructive pulmonary dysfunction.

Among 2,358 surgical patients who, between September 2009 and February 2010, underwent spirometry at the Tokai University Hospital, the 333 whose forced expiratory volume in 1 second (FEV1) / forced vital capacity ratio was <0.7 were studied retrospectively. Single and multiple variable logistic regression analyses were performed in search of predictors of need for drug therapy.

Among the 230 men and 103 women (mean age = 68 ± 11 years) with obstructive pulmonary dysfunction, 108 (32%) received perioperative drug therapy with bronchodilators, inhaled corticosteroids or both. By multiple variable analysis, perioperative drug therapy was significantly correlated with a history of asthma and ever smoking, cough or sputum production, FEV1 <50% predicted, and emphysema, independently of consultations with pulmonologists. In a decision tree analysis, FEV1 and smoking history were the independent predictors of perioperative drug therapy.

Composite assessment of clinical history, respiratory symptoms, and pulmonary function is necessary for the efficient screening of the subjects who require perioperative drug therapy for obstructive pulmonary dysfunction.