No further diagnostic studies are needed for this asymptomatic patient scheduled for surgery. For patients with no history of cardiopulmonary disease and no cardiac or respiratory symptoms, preoperative pulmonary diagnostic testing is not beneficial. Moreover, these studies add considerable cost and potential risk (for example, radiation exposure with chest radiography). Although smoking is a risk factor for postoperative pulmonary complications, a history of smoking without other evidence of disease is not an indication for chest radiography, spirometry, or arterial blood gas analysis in the general or preoperative setting. Several studies have demonstrated that these studies do not offer improved prognostic value beyond clinical assessment alone and rarely alter management.

Chest radiography may be considered in patients with known cardiopulmonary disease or symptoms. Spirometry assessment is frequently done prior to cardiothoracic surgery, but its value is limited for other types of surgery. For nonthoracic surgery, spirometry should be performed for the same reasons as in a nonoperative situation (for example, evaluation of dyspnea or hypoxia). Similarly, preoperative arterial blood gas analysis may identify hypercapnia in patients at risk for carbon dioxide retention, but studies have not shown an incremental diagnostic benefit with this testing.