5 The pulmonary risk patient

Chronic pulmonary diseases are among the leading causes of death, and pulmonary complications are frequent causes of peri-operative morbidity and mortality in thoracic and in non-thoracic surgery. Pre-operative risk assessment is important to prevent perioperative complications. It is the aim of this chapter to review recent reports on perioperative pulmonary risk factors and to discuss controversial aspects. Patients at risk in non-thoracic surgery are best identified by a detailed history, careful clinical examination and overall co-morbidity scoring systems. Pulmonary function tests, however, do not predict peri-operative complications and therefore should not be used alone to decide on the patient's operability. Also, conventional, so-called prohibitive lung function parameters should no longer be used to deny a potentially curative resection of lung tissue. Alternatively, more significant parameters need to be identified. Because evidence-based data are not available, an interdisciplinary approach to specific problems of severely compromised or co-morbid patients is mandatory.