Preoperative pulmonary assessment before noncardiothoracic surgery in adults

Routine preoperative pulmonary assessment is not needed for the majority of patients undergoing non-cardiothoracic surgery. Exceptions include those with new or poorly controlled cardiopulmonary disease. This algorithm has been developed for use with UpToDate content on perioperative management. Additional work-up, including extensive pulmonary function testing, is required for patients undergoing lung resection. Additional chest imaging may be required for cardiothoracic surgeries. For additional information please refer to UpToDate topics on pre-operative evaluation, post-operative pulmonary complications, and evaluation for cardiac, thoracic, and lung resection surgery

COPD: chronic obstructive pulmonary disease; CXR: chest x-ray (radiograph).

* Some patients may not need additional testing but may still be at high risk of pulmonary or other perioperative complications due to the known severity of their cardiac or pulmonary disease.

¶ Primary care or pulmonary evaluation and treatment with bronchodilators and glucocorticoids is often appropriate for those with poorly controlled obstructive lung disease. Those with evidence of worsened pulmonary disease but without significant/worsening obstruction on spirometry may require additional evaluation.

Δ For patients who do not have obstructive lung disease on spirometry and CXR, further evaluation may be needed to determine the etiology of symptoms. This may include sputum culture, testing for respiratory viruses, electrocardiography, complete pulmonary function testing, chest computed tomography echocardiography, and/or cardiac stress testing. Please refer to UpToDate content on the evaluation of patients with chest pain, shortness of breath, wheezing, edema, new heart murmurs, and dysrhythmias.

◊ In addition to CXR, further evaluation to determine the etiology of symptoms is often warranted and may include sputum culture, testing for respiratory viruses, electrocardiography, complete pulmonary function testing, chest computed tomography echocardiography, and/or cardiac stress testing. Please refer to UpToDate content on the evaluation of patients with chest pain, shortness of breath, wheezing, edema, new heart murmurs, and dysrhythmias.

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Preoperative pulmonary assessment before noncardiothoracic surgery in adults