Avaliação do Risco Cirúrgico em Pacientes com DPOC Evaluation of Surgical Risk in Patients with COPD

It is known that COPD is a major risk factor for postoperative pulmonary complications following thoracic or non-thoracic surgery. The aim of this review is to present the main advances in the pre-operative approach and measures to prevent the severity of postoperative pulmonary complications. In clinical practice, predicted post-operative values of 40% for FEV1 and 40% for DLCO have been proposed as the minimum values for surgical decision making. However, the destruction of the lung architecture caused by emphysema has hampered the assessment of surgical risk in COPD patients because of regional differences in ventilation and perfusion. The use of single-photon-emission CT and multi-detector CT has been proposed as a means of addressing this issue. Currently, cardiopulmonary exercise testing remains the method of choice to evaluate surgical risk, maximal oxygen consumption greater than 35% being considered the best criterion of operability. To estimate the extent of emphysema, novel imaging techniques should be incorporated into the pre-operative evaluation of COPD patients with borderline pulmonary function.