Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease

TLDR

Surgery for COPD patients requires careful preoperative assessment, including exercise capacity thresholds and DVT prophylaxis. The study seeks to establish criteria for lung resection in COPD patients. Preoperative assessment includes spirometry, exercise testing, and DVT prophylaxis with low‑dose heparin or pneumatic compression. An FEV1 >2 L or >60 % predicted is acceptable for pneumonectomy; lower predicted values (<40–50 % of normal) predict higher morbidity and mortality and warrant additional testing.

Abstract

SUMMARY OF APPROACH The approach to surgery in the patient with COPD is summa-rized below. Surgery Definitely indicated Lung resection. Pulmonary function studies should be performedbefore lung resection. Simple spirometry has the greatest utilityin documenting physiologic operability. FEV, > 2 L in an adultman or > 60% of predicted is acceptable for pneumonectomy.Values below this suggest that further studies, such as split func-tion assessment by quantitative lung scintigraphy and exercisetesting, are warranted.FEV, predicted after lung resection to be less than 40 to 50%of normal for the patient’s sex, age, and height suggests highermorbidity and mortality. An exercise 90, of less than 10 to 15ml/min per kg of body weight is associated with higher mor-bidity and mortality after lung resection.All elective surgery Prophylaxis against deep venous throm-bosis should be given before most procedures that will requirepostoperative bed rest or significantly reduce mobility. Heparinin low doses seems well accepted for most procedures. Externalpneumatic compression of the lower legs can be used when anti-coagulants are contraindicated.