Predictive Ability of Preoperative Indices for Major Pulmonary Surgery

We examined existing functional algorithms used for selection of candidates for lung resection. Evidence has shown that ppoFEV₁ is not a reliable predictor of complications in patients with COPD; it overestimates the actual FEV₁ in the first postoperative days when most complications occur. DLCO measurement is recommended only in patients with reduced FEV₁ on the assumption that FEV₁ and DLCO are highly correlated. Many patients with normal FEV₁ have reduced diffusion capacity and a low ppoDLCO is a reliable predictor of complications. Exercise tests are better predictors of early outcome than traditional respiratory measures, as they assess the global performance of the cardiorespiratory system. Their role in surgical risk stratification needs to be better defined by future investigations.