Pulmonary Function Tests for the Prediction of Postoperative Pulmonary Complications

Abstract

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 non-thoracic 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 non-thoracic surgery. Spirometry should be considered in individuals with key indicators for chronic obstructive pulmonary disease (COPD) scheduling for upper abdominal surgery.

Figures

Figure 1

PRISMA-DTA flowchart PRISMA-DTA, Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

Figure 2

Quality assessment of the studies by means of QUADAS- 2, cumulative results: QUADAS-2 evaluates the risk of bias and the clinical applicability in four domains: 1) patient selection, 2) index test, 3) reference standard, 4) flow and timing. The potential for bias was assessed in each domain using signaling questions. QUADAS, Quality Assessment of Diagnostic Accuracy Studies