Introduction Lung function testing is a useful component of the pre-operative assessment of patients being considered for major surgery. Current national and international guidelines suggest that the presence of a thoracic aortic aneurysm is a contra-indication to testing as the major swings in intra-thoracic pressure that occur during lung function testing may precipitate rupture of the aneurysmal sac. The evidence base for this recommendation is minimal and based on expert opinion only.
Aims To audit the use of pulmonary function testing in the pre-operative assessment of patients with a thoracic or thoraco-abdominal aortic aneurysm.
Methods All patients who were referred to a tertiary vascular surgical unit for elective or urgent repair of a thoracic or thoraco-abdominal aortic aneurysm over a 60 month period (January 2005 until January 2010) were included in the audit. Patients who were referred as an emergency, or assessed for surgery but not treated, were excluded. Pre-operative pulmonary function studies for these patients were reviewed, particularly any comments by the Physiologist. Incident reports for the Respiratory Physiology Laboratory during this period were also requested.
Results 183 patients were referred and subsequently operated on. Of these, lung function test results were not available for 11 patients. Of the remaining 172 patients, no adverse incidents (either immediate or late) were recorded for 171 patients. One patient complained of pain during tests but the nature of this pain, or any associated adverse event, was not documented. This patient proceeded to elective repair of the aneurysm 8 days after testing. There were no clinical incident forms submitted from the Respiratory Physiology Laboratory during this period associated with patients undergoing an aortic aneurysm repair workup.
Conclusions Our findings suggest that the pre-operative assessment of patients being considered for aortic aneurysm repair can safely include lung function testing. We suggest collating data from other vascular surgical units to confirm our observations and thus inform future guideline development.