Tests of pulmonary function before thoracic surgery

Respiratory function declines following surgery due to atelectasis. After thoracic surgery, there is an even greater decline due to resection and lung handling. Patients undergoing thoracic surgery often have concomitant respiratory disease and testing pulmonary function pre-operatively allows: diagnosis and optimization of lung disease; counselling of patients accurately to obtain truly informed consent and guide the multidisciplinary team to the best operation. Tests of pulmonary function can be divided into tests of mechanical function, tests of parenchymal function, tests of cardiorespiratory reserve and function, and anatomical tests. When these tests are combined with knowledge of the lobes resected they allow predicted postoperative values to be calculated. Evidence-based guidelines show which investigations should be performed preoperatively and risk-stratify patients for postoperative dyspnoea, morbidity and mortality.