NDLI: Future trends in preoperative evaluation.

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Year: 2007 Volume: 17

Future trends in preoperative evaluation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Varela, Gonzalo Novoa, Nuria M.
Description	Country affiliation: Spain Author Affiliation: Varela G ( Service of Thoracic Surgery, Salamanca University Hospital, Paseo San Vicente 58-182, Salamanca, Spain. gvs@usal.es)
Abstract	Preoperative evaluation before lung resection has been frequently addressed in modern medical literature. Actual or predicted pulmonary volumes are considered relevant to predict the risk of surgery. Nevertheless, ppoFEV1 underestimates the real functional loss in the immediate postoperative period when most of the complications occur. Not all patients, however, have comparable functional changes after lobectomy. Minimal impairment or even improvements have been demonstrated in COPD cases after lobectomy. Efforts should be directed to an accurate prediction of the immediate postoperative pulmonary volumes for a better evaluation of high-risk patients caused by respiratory impairment. Future developments are needed on the role of measuring preoperative DLCO and how to evaluate a patient's general cardiorespiratory status. Evidence underlines the relevance of routine evaluation of preoperative DLCO at rest or, better, during exercise for a thorough assessment of patient's capability to adapt to a stressful situation (Fig. 3). Only by improving knowledge about the general condition of the patient, can one assess the physiologic response to surgery. Widespread use of sophisticated or simple exercise tests and measurements or daily activity using motion detectors can identify high-risk patients with otherwise acceptable pulmonary volumes. Another suggested investigation issue is to develop different relevant outcome parameters, not only from the surgeon's point of view but also from the patient's perspective, such as postoperative QOL-related variables or delayed outcomes. Finally, multidisciplinary investigation teams, including experts in mathematical modeling, are essential to improve the quality and validity of the developed models. Although knowledge about perioperative physiologic changes has increased, clinicians are still far from finding a way to put all this knowledge down and make it applicable for an individual patient. Multicentric cooperation and evaluation of large prospectively recorded databases are essential to develop evidence-based clinical guidelines on preoperative evaluation.
File Format	HTM / HTML
ISSN	15474127
Issue Number	1
Volume Number	18
Journal	Thoracic Surgery Clinics
Language	English
Publisher	Elsevier
Publisher Date	2008-02-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Surgery Discipline Pulmonary Medicine Pneumonectomy Trends Preoperative Care Pulmonary Disease, Chronic Obstructive Physiopathology Exercise Test Forced Expiratory Volume Physiology Humans Patient Selection Pulmonary Diffusing Capacity Surgery Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery

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