Identification and evaluation of the patient with lung disease.

Preoperative pulmonary evaluation and optimization improves postoperative patient outcomes. Clinicians frequently evaluate patients with pulmonary disease before surgery who are at increased risk for pulmonary and nonpulmonary perioperative complications. Postoperative pulmonary complications are as common and costly as cardiac complications. In this article, the evaluation of patients with the most common conditions encountered in the preoperative setting, including unexplained dyspnea, asthma, chronic obstructive pulmonary disease, obstructive sleep apnea, and cigarette use, are discussed. Risk stratification for postoperative pulmonary complications and strategies to reduce them for high-risk patients are also discussed. From the available literature, high-risk patients and those patients for whom a multidisciplinary collaboration will be most helpful can be accurately identified.