Pulmonary Function Tests for the Prediction of Postoperative Pulmonary Complications

TY - JOUR

T1 - Pulmonary Function Tests for the Prediction of Postoperative Pulmonary Complications

T2 - A Systematic Review

AU - Dankert, Andre

AU - Dohrmann, Thorsten

AU - Löser , Benjamin

AU - Zapf, Antonia

AU - Zöllner, Christian

AU - Petzoldt, Martin

PY - 2022/2/18

Y1 - 2022/2/18

N2 - Background: Pulmonary function tests (PFTs) such as spirometry and blood gas analysis have been claimed to improve preoperative risk assessment. This systematic review summarizes the available scientific literature regarding the ability of PFTs to predict postoperative pulmonary complications (PPC) in nonthoracic surgery.Methods: We systematically searched MEDLINE, CINAHL, and the Cochrane Library for pertinent original research articles (PROSPERO CRD42020215502), framed by the PIT-criteria (PIT, participants, index test, target conditions), respecting the PRISMA-DTA recommendations (DTA, diagnostic test accuracy).Results: 46 original research studies were identified that used PFT-findings as index tests and PPC as target condition. QUADAS-2 quality assessment revealed a high risk of bias regarding patient selection, blinding, and outcome definitions. Qualitative synthesis of prospective studies revealed inconclusive study findings: 65% argue for and 35% against preoperative spirometry, and 43% argue for blood gas analysis. A (post-hoc) subgroup analysis in prospective studies with low-risk of selection bias identified a possible benefit in upper abdominal surgery (three studies with 959 participants argued for and one study with 60 participants against spirometry).Conclusion: As the existing literature is inconclusive it is currently unknown if PFTs improve risk assessment before nonthoracic surgery. Spirometry should be considered in individuals with key indicators for chronic obstructive pulmonary disease (COPD) scheduling for upper abdominal surgery.

AB - Background: Pulmonary function tests (PFTs) such as spirometry and blood gas analysis have been claimed to improve preoperative risk assessment. This systematic review summarizes the available scientific literature regarding the ability of PFTs to predict postoperative pulmonary complications (PPC) in nonthoracic surgery.Methods: We systematically searched MEDLINE, CINAHL, and the Cochrane Library for pertinent original research articles (PROSPERO CRD42020215502), framed by the PIT-criteria (PIT, participants, index test, target conditions), respecting the PRISMA-DTA recommendations (DTA, diagnostic test accuracy).Results: 46 original research studies were identified that used PFT-findings as index tests and PPC as target condition. QUADAS-2 quality assessment revealed a high risk of bias regarding patient selection, blinding, and outcome definitions. Qualitative synthesis of prospective studies revealed inconclusive study findings: 65% argue for and 35% against preoperative spirometry, and 43% argue for blood gas analysis. A (post-hoc) subgroup analysis in prospective studies with low-risk of selection bias identified a possible benefit in upper abdominal surgery (three studies with 959 participants argued for and one study with 60 participants against spirometry).Conclusion: As the existing literature is inconclusive it is currently unknown if PFTs improve risk assessment before nonthoracic surgery. Spirometry should be considered in individuals with key indicators for chronic obstructive pulmonary disease (COPD) scheduling for upper abdominal surgery.

KW - Humans

KW - Postoperative Complications/diagnosis

KW - Prospective Studies

KW - Pulmonary Disease, Chronic Obstructive/complications

KW - Respiratory Function Tests/adverse effects

KW - Spirometry/adverse effects

UR - https://pubmed.ncbi.nlm.nih.gov/34939921/

U2 - 10.3238/arztebl.m2022.0074

DO - 10.3238/arztebl.m2022.0074

M3 - SCORING: Review article

C2 - 34939921

VL - 119

SP - 99

EP - 106

JO - DTSCH ARZTEBL INT

JF - DTSCH ARZTEBL INT

SN - 1866-0452

IS - 7

ER -