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(Chest. 1999;116:474S-476S.)
© 1999 American College of Chest Physicians

Evidence-Based Preoperative Evaluation of Candidates for Thoracotomy*

John J. Reilly, Jr, MD, FCCP

* From the Division of Pulmonary and Critical Care, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA

Correspondence to: John J. Reilly, Jr, MD, FCCP, Associate Professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital, 7S Francis Street, Boston, MA 02115.

1. All patients considered for thoracotomy should have preoperative spirometry. 2. Patients meeting the criteria outlined below should also have quantitative radionuclide perfusion scanning. 3. Patients felt to be at high risk on the basis of predicted postoperative FEV1 should be considered for exercise assessment. 4. If exercise assessment is performed, an MO2 of < 10–15 mL/kg/min or a predicted postoperative MO2 < 10 mL/kg/min identifies a patient at very high risk for complications and mortality. 5. Limited available data support the use of preoperative risk indices to identify patients at high risk (See Table 4 ). 6. Lung volume reduction surgery may provide new approaches in selected patients with significant obstructive lung disease and concomitant lung cancer.




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