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A Critical Appraisal of Its Predictive Value

Valerie A. Lawrence, MD; Carey P. Page, MD; Gary D. Harris, MD

Arch Intern Med. 1989;149(2):280-285.

Abstract
• Preoperative spirometry is commonly ordered before abdominal surgery, with the goal of predicting and preventing postoperative pulmonary complications. We assessed the evidence for this practice with a systematic literature search and critical appraisal of published studies. The search identified 135 clinical articles, of which 22 (16%) were actual investigations of the use and predictive value of preoperative spirometry. All 22 studies had important methodological flaws that preclude valid conclusions about the value of screening preoperative spirometry. The available evidence indicates that spirometry's predictive value is unproved. Unanswered questions involve (1) the yield of spirometry, in addition to history and physical examination, in patients with clinically apparent lung disease; (2) spirometry's yield in detecting surgically important occult disease; and (3) its utility, or beneficial effect on patient outcome. Spirometry's full potential for risk assessment in the individual patient has not yet been realized.

(Arch intern Med 1989;149:280-285)

Author Affiliations
From the Departments of Medicine (Drs Lawrence and Harris) and Surgery (Dr Page), University of Texas Health Science Center at San Antonio, and Audie L. Murphy Memorial Veterans Hospital, San Antonio, Tex.

Footnotes
Accepted for publication March 22, 1988.

Reprint requests to Division of General Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284-7879 (Dr Lawrence).

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