Correspondence (reply): In Reply

A principal foundation of our article is the rule that the indication for further diagnostic testing is based on the patient’s history and a physical examination. The routine screening of asymptomatic patients, which was common practice in the past, has been consistently abandoned, because many results are of no relevance for anesthesia and the surgery, and the rate of false-positive results, triggering unnecessary tests, is very high. This was shown in a systematic review which found no evidence to support the practice to routinely obtain preoperative chest x-rays or lung function tests (1). It is crucial that patients undergo targeted and adequate diagnostic investigation. For example, a chest x-ray may be indicated in patients with severe chronic obstructive pulmonary disease, with previously unknown pulmonary or cardiac symptoms, and with gastrointestinal malignancies (2). In contrast, experts do not consider the smoking status as an indication (3). From this, it becomes clear that routine screening does not improve patient safety in the perioperative process. Should there be further indications for obtaining a preoperative chest x-ray, these must be supported by studies. Then, it is necessary to differentiate between a global screening method and a preoperative risk evaluation. If one sees the chest radiograph as a suitable diagnostic modality for the early detection of lung cancer in smokers, the screening examination should be carried out independent of a planned surgery. Waiting for an operation could mean that precious time is lost and it may be too late for a surgical intervention. Preoperative risk evaluation can and should not fill this “gap”.