Preoperative Pulmonary Function and Postoperative Pulmonary Complications in Noncardiac Surgery: A Propensity...

Postoperative pulmonary complications (PPCs) increase surgical morbidity and mortality. While the predictive value of preoperative pulmonary function tests (PFTs) in noncardiac surgery remains unclear, we evaluated whether abnormal PFT patterns and spirometric indices are independently associated with PPCs.

We retrospectively analyzed adult patients undergoing noncardiac surgery under general or spinal anesthesia between June and November 2022 with preoperative spirometry. PFTs were classified as normal or abnormal using lower limit of normal criteria. PPCs within 7 postoperative days were defined using European Perioperative Clinical Outcome criteria. Associations were assessed using multivariable logistic regression before and after propensity score-based overlap weighting. Continuous spirometric indices were also analyzed.

Among 729 patients, 64 (8.8%) had abnormal PFTs. PPCs were significantly more frequent in the abnormal PFTs group (29.7% vs. 8.7%; p < 0.001). After overlap weighting, abnormal PFTs remained independently associated with PPCs (adjusted odds ratio [aOR] 4.05, 95% CI 1.72-9.53; p < 0.001), along with open surgery (aOR 8.94, 95% CI 2.38-33.59; p = 0.001). Lower FEV₁ and %FEV₁ were consistently associated with increased PPC risk across all models, whereas associations with FVC and FEV₁/FVC were inconsistent.

Abnormal preoperative PFTs and reduced FEV₁ are independently associated with PPCs after noncardiac surgery. Preoperative spirometry aids perioperative risk stratification, particularly for invasive surgery.