Assessing adherence to pre-operative spirometry testing guidelines among medical doctors in Malta

Abstract

BACKGROUND: Pulmonary complications arising from surgical procedures are frequently encountered in the clinical setting, resulting in high levels of patient morbidity and mortality. It is important to assess the risk of developing these complications during the pre-operative assessment. Spirometry is a simple and non-invasive means of evaluating pulmonary function, yet it should not be utilised unnecessarily.

AIMS: To assess whether pre-operative spirometry requests at Mater Dei Hospital, Malta are indicated.

METHODS: A retrospective analysis of all pre-operative spirometry requests and tests during September 2022 at the Pulmonary Function Lab at Mater Dei Hospital was performed. Patient characteristics were noted from the pre-operative assessment note. The local guideline entitled ‘pre-operative generic investigations for adult elective surgery’ was used as the gold standard to determine whether the spirometry request was indicated.

RESULTS: A total of 156 patients had pre-operative spirometry performed in September 2022. Pre-operative spirometry testing was not indicated in 63.5% (n= 99). Patients in whom spirometry was indicated, 54.3% (n=31) had an American Society of Anaesthesiologists (ASA) classification of 3 or above, 29.8% (n=17) were unable to climb two flights of stairs, and 15.8% (n=9) had both indications.

CONCLUSION: Routine ordering of spirometry is discouraged in the pre-operative period. Instead, pre-operative spirometry should be requested if the patient is classified as an ASA of 3 or above, or if they cannot manage to climb two flights of stairs. Taking a careful approach to choosing which patients undergo pre-operative spirometry could result in reduced costs and shorter waiting times.