Preoperative assessment of pulmonary risk.

STUDY OBJECTIVES: A summary of current modalities for and the utility of preoperative assessment of pulmonary risk.

DESIGN: Review of recent literature published in the English language.

SETTING: Not applicable.

PATIENTS OR PARTICIPANTS: Patients who undergo elective cardiothoracic or abdominal operations.

INTERVENTIONS: Not applicable.

MEASUREMENTS AND RESULTS: Postoperative pulmonary complications occur after 25 to 50% of major surgical procedures. The accuracy of the preoperative assessment of the risk of such complications is only fair. The routine assessment for all preoperative patients includes age, general physiologic status, and the nature of the planned operation. Specific tests such as measurement of spirometric values and diffusing capacity are indicated routinely only for patients who are candidates for major lung resection or esophagectomy.

CONCLUSIONS: Pulmonary complications are an important form of postoperative morbidity after major cardiothoracic and abdominal operations. The appropriate preoperative assessment of the risk of such complications is well defined for lung resection and esophagectomy operations, but it requires refinement for general surgical and cardiovascular operations.