Cardiopulmonary Testing Before Lung Resection: What Are Thoracic Surgeons Doing?

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Clinical Practice Guidelines

Background:

• Preoperative cardiopulmonary assessment is crucial for risk stratification before lung resection.
• The American College of Chest Physicians (ACCP) provides guidelines to support decision-making in these assessments.

Purpose of the Study:

• To evaluate the current cardiopulmonary assessment practices of thoracic surgeons.
• To determine the extent of adherence to ACCP guidelines among these surgeons.

Main Methods:

• An anonymous survey was distributed to 846 thoracic surgeons.
• Responses were analyzed based on practice type (general thoracic vs. cardiothoracic) and years in practice.
• Survey data was compared against ACCP guideline recommendations.

Main Results:

• A 24.0% response rate was achieved (n=203).
• Most surgeons (59.6%) used a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40%.
• Experienced surgeons were more likely to vary thresholds by surgical approach (P=.007).
• Significant differences in referral practices to cardiology were observed between general thoracic and cardiothoracic surgeons (P<.001).
• Only 0.5% of respondents were 100% adherent to ACCP guidelines, with 4.4% and 45.8% adhering to 75% and 50% of guidelines, respectively.

Conclusions:

• There is considerable variation in preoperative cardiopulmonary assessment practices among thoracic surgeons.
• These variations differ by practice type and surgeon experience.
• Marked discordance with ACCP guidelines was observed, warranting further investigation into the impact of adherence on patient outcomes.