Can preoperative spirometry be omitted for HBP surgery?

PURPOSE: Postoperative pneumonia (POP) is a major complication of hepatobiliary and pancreatic surgery that significantly affects patient outcomes. However, the necessity of routine preoperative spirometry to assess the risk of POP remains uncertain. We therefore evaluated whether or not omitting routine preoperative spirometry affects the postoperative outcomes, particularly the incidence of POP. METHODS: This retrospective study included 691 patients who underwent hepatobiliary and pancreatic surgeries at our institution. Patients were categorized into two groups: the pre-COVID-19 group (April 2018 to March 2020), wherein all patients underwent spirometry, and the COVID-19 group (April 2020 to March 2022), with limited spirometry. This study evaluated postoperative outcomes and risk factors for POP in both groups. RESULTS: No significant differences were observed in the incidence of POP between the pre-COVID-19 and COVID-19 era groups (2.9% vs. 2.3%, p = 0.6197) or between patients with and without spirometry during the COVID-19 period (2.1% vs. 2.5%, p = 1.0000). Abnormal spirometry results were independent risk factors for POP and were significantly associated with male sex, a history of lung disease, and abnormal chest imaging findings. CONCLUSIONS: In patients undergoing hepatobiliary and pancreatic surgery, omitting routine preoperative spirometry did not adversely affect postoperative outcomes, including POP incidence. Therefore, targeted spirometry may be acceptable.