Table 1. Qualitative synthesis of identified prospective studies that investigated the association between spirometry and postoperative pulmonary complications.
| Study | Cohort | Findings | |||
| First author,year (reference) | Number of patients | Preselection: type of surgery | Preselection: demographics and comorbidity | For/ against spirometry*1 | Positive index test |
| Collins 1968*2 (e1) | 120 | Upper abdomen | Only men |
 for |
FEV1, FVC |
| Stein 1970*2 (e2) | 77 | Mixed | At discretion*3 |
for |
abnormal PFT |
| Latimer 1971 (e3) | 46 | Upper abdomen | – |
for |
abnormal PFT |
| Appleberg 1974 (e4) | 100 | Mixed | Respiratory high-risk patients excluded |
 for*4
|
FEV1/FVC |
| Gracey 1979 (e5) | 157 | Mixed | COPD, at discretion*3 |
for |
FEF25–75% |
| Crapo 1986 (e6) | 114 | Gastric bypass | – |
against |
– |
| Fogh 1987 (e7) | 125 | Major abdominal ‧surgery | – |
against*4
|
abnormal PFT |
| Poe 1988 (e8) | 209 | Cholecystectomy | 20–70 years |
for*5
|
MEFV, SBN2 |
| Roukema 1988*2 (e9) | 153 | Upper abdomen | Only patients without pulmonary risk factors |
against |
– |
| Svensson 1991*2 (e10) | 98 | Thoracoabdominal aortic surgery | – |
for*5
|
FEV1, FEV1 %, FVC, FVC %, FEF25, FEF25%, FEF25–75 |
| Rao 1992 (e13) | 73 | Head and neck | – |
for |
FEV1 %, peak flow |
| Williams-Russo 1992 (e14) | 278 | Mixed | Hypertension, diabetes |
against |
– |
| Kocabas 1996 (e17) | 60 | Upper abdomen | – |
against*6
|
FEF25–75%, MVV %, abnormal PFT |
| Barisione 1997 (e19) | 361 | Upper abdomen | – |
for |
FEV1, FEV1 %, IVC, FEV1/IVC, TLCO,SB, TLCO,SB %, RV |
| Mitchell 1998 (e20) | 148 | Non-thoracic surgery | ≥ 40 years |
against |
– |
| Pereira 1999 (e21) | 247 | Upper abdomen | > 60 years, pulmonary disease, obesity, smoker or respiratory symptoms |
for*7
|
FEV1/FVC |
| Girish 2001 (e23) | 83 | Upper abdominal and thoracic surgery | – |
for |
FEV1, FVC |
| McAlister 2003 (e24) | 272 | Non-thoracic surgery | At discretion*3 |
for |
FEV1, FVC |
| Ong 2004*2 (e25) | 86 | Major head and neck interventions | < 80 years, without respiratory tract disease or diabetes |
for |
FEV1/FVC |
| McAlister 2005 (e26) | 1 055 | Non-thoracic surgery | Low-risk patients without sleep apnea, medical problems, planned ICU admission |
against |
FEV1, FVC, FEV1/FVC |
| Kanat 2007 (e27) | 60 | Upper abdomen | – |
for |
FVC, FEV1/FVC |
| Sunpaweravong 2012 (e31) | 232 | Esophagectomy | – |
for |
FEV1%, FVC% |
| Jeong 2013 (e33) | 538 | Gastrectomy for gastric cancer | – |
for*8
|
FEV1/FVC |
| Atilla 2017 (e41) | 173 | Laparoscopic sleeve ‧gastrectomy | – |
against |
– |
| Shin 2017 (e42) | 694 | Non-thoracic surgery | COPD, ≥ 40 years, at discretion*3 |
for*9
|
FEV1 % |
| Sankar 2020 (e46) | 1 200 | Mixed non-cardiac surgery | ≥ 40 years, ≥ 1 cardiac risk factor, FEV 1 % ≥ 30% |
against*10
|
– |
= univariate analysis, = multivariate analysis; study design: findings/conclusions based on: = univariate analysis, = multivariate analysis
*1 Conclusions drawn by the authors based on published study findings and clinical considerations
*2 Only secondary analysis from an RCT that was not conducted to investigate PFT
*3 Patients were preselected at the discretion of a physician (in most cases a surgeon or anesthetist) and referred to an internist, pulmonologist, respiratory physician, or specialized department (referral patterns must be considered)
*4 Conclusion based on changes of the predictive value
*5 Multivariable analysis performed but conclusions based on univariate findings
*6 Clinical variables appeared to be non-inferior to spirometry
*7 FEV1 /FVC was no longer a predictor when COPD was included in the multivariable model
*8 Multivariable analysis was performed only for the outcome variable “postoperative morbidity” (this includes surgical complications such as anastomosis leakage and wound complication)
*9 Study cohort was divided into five quintiles of airflow obstruction severity(FEV 1); quintiles 1 to 4 served as reference cohort for the patients in the fifth quintile
*10 Secondary analysis from a multicenter study that found no strong evidence for FEV1 predicting respiratory morbidity after adjustment for peak oxygen consumption or ventilatory efficiency
COPD, Chronic obstructive pulmonary disease; FEF, forced expiratory flow; FEF25–75%, mean forced expiratory flow over 25–75% of the FVC; FEV 1, forced expiratory volume in one second; FVC, forced vital capacity; MEFV, maximum expiratory flow volume; MVV, maximum voluntary ventilation; PFT, pulmonary function test; RV, residual volume; SBN2, single-breath lung diffusion capacity using nitrogen test; T LCO,SB, transfer factor of lung for carbon monoxide by single-breath method; VC, vital capacity