Preoperative Pulmonary Function Testing Decreased After ACP Guidelines

Louise Sun, MD SM FRCPC Assistant Professor Department of Anesthesiology, University of Ottawa Staff | Division of Cardiac Anesthesiology University of Ottawa Heart InstituteMedicalResearch.com Interview with:
Louise Sun, MD SM FRCPC
Assistant Professor Department of Anesthesiology,
University of Ottawa Staff | Division of Cardiac Anesthesiology
University of Ottawa Heart Institute

Medical Research: What is the background for this study? What are the main findings?

Dr. Sun: Preoperative testing provides important information for perioperative
planning and decision-making. However, given the rapid increase in health
care costs, there has been growing emphasis on the more rational use of
resources and thus the need to better understand the utilization patterns
of specific tests. Preoperative pulmonary function tests (PFTs) are
important in helping perioperative physicians identify patients at risk
for postoperative pulmonary complications, but few appropriate use
guidelines exist for this test. We conducted a population-based study
using linked administrative databases in Ontario, Canada to describe
temporal trends in preoperative pulmonary function tests
and assess whether the recent 2006 American College of Physicians (ACP) guidelines on risk assessment and prevention of postoperative pulmonary complications for non-cardiothoracic surgery influenced these trends.

We examined 511,625 individuals undergoing non-cardiothoracic surgery, amongst whom
3.6% underwent preoperative pulmonary function tests while 3.3% had non-operative PFTs.

Preoperative pulmonary function tests rates decreased over the study period and following the 2006 ACP guidelines while non-operative rates remained stable. By 2013,
preoperative pulmonary function tests were performed in fewer than 8% of Ontario patients with risk factors for pulmonary complications, while preoperative testing
rates among individuals without known respiratory disease had approached
rates seen in the non-operative setting. The decreasing preoperative pulmonary function tests rates contrast starkly against concurrent increases in rates of other
perioperative interventions such as preoperative anesthesia consultations
and stress testing.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sun: Given the low overall rate of preoperative pulmonary function tests, large-scale efforts to reduce this testing are likely unnecessary. Also, the decreasing
preoperative pulmonary function tests rates were unlikely to have been solely due to the 2006 ACP guidelines and may in part be explained by increased use of bedside
spirometry, which is not captured by provincial administrative databases.
While less costly and possibly more accessible at some hospitals, these
alternative tests have limitations such as measurement error.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sun: We believe that our findings point to the need for more research to
identify which select group of surgical patients most benefit from
preoperative pulmonary function tests.

Citation:

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Louise Sun, MD SM FRCPC, Assistant Professor Department of Anesthesiology,, University of Ottawa Staff | Division of Cardiac Anesthesiology, & University of Ottawa Heart Institute (2015). Preoperative Pulmonary Function Testing Decreased After ACP GuidelinesĀ