Should pulmonologists be gatekeepers or supporters for preoperative patients?

Postoperative pulmonary complications (PPCs) are considered as a leading cause of poor surgical outcomes, and occur frequently even in non-cardiothoracic surgery. Several multifactorial risk indices show potential effectiveness in identification of patients at high risk of developing PPCs. In preoperative consultation from surgeons, pulmonologists often act as gatekeepers for indication of surgery. With regard to preventive strategy for PPCs, recent reports have suggested the usefulness of preoperative interventions, such as smoking cessation, inhalation therapy, medications, pulmonary rehabilitation, and sleep study followed by continuous positive airway pressure therapy. Now, pulmonologists have an important role as supporters for preoperative patient care.