Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study
Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study
BACKGROUND: Postoperative complications are associated with reduced fitness. Cardiopulmonary exercise testing (CPET) has been used in risk stratification. We investigated the relationship between preoperative CPET and in-hospital morbidity in major colonic surgery.
METHODS: We prospectively studied 198 patients undergoing major colonic surgery (excluding neoadjuvant cancer therapy), performing preoperative CPET (reported blind to clinical state), and recording morbidity (assessed blind to CPET), postoperative outcome, and length of stay.
RESULTS: Of 198 patients, 62 were excluded: 11 had emergency surgery, 25 had no surgery, 23 had incomplete data, and three were unable to perform CPET. One hundred and thirty-six (89 males, 47 females) were available for analysis. The median age was 71 [inter-quartile range (IQR) 62-77] yr. Sixty-five patients (48%) had a complication at day 5 after operation. Measurements significantly lower in patients with complications than those without were O2 uptake () at estimated lactate threshold () [median 9.9 (IQR 8.3-12.7) vs 11.2 (9.5-14.2) ml kg-1 min-1, P<0.01], at peak [15.2 (12.6-18.1) vs 17.2 (13.7-22.5) ml kg-1 min-1, P=0.01], and ventilatory equivalent for CO2 (/) at [31.3 (28.0-34.8) vs 33.9 (30.0-39.1), P<0.01]. A final multivariable logistic regression model contained at {one-point change odds ratio (OR) 0.77 [95% confidence interval (CI) 0.66-0.89], P<0.0005; two-point change OR 0.61 (0.46-0.81) and gender [OR 4.42 (1.78-9.88), P=0.001]}, and was reasonably able to discriminate those with and without complications (AUC 0.71, CI 0.62-0.80, 68% sensitivity, 65% specificity).
CONCLUSIONS: CPET variables are associated with postoperative morbidity. A multivariable model with at and gender discriminates those with complications after colonic surgery.
anaerobic threshold, cardiopulmonary exercise test, colorectal surgery, morbidity, postoperative complications
665-671
West, M.A.
98b67e58-9875-4133-b236-8a10a0a12c04
Lythgoe, D.
123c3e46-3677-4588-a199-2f79e6e96d6f
Barben, C.P.
9ea1cefa-a22c-422c-b72d-24459c633d4f
Noble, L.
d552b08b-12a3-4187-90f5-78b53885348d
Kemp, G.J.
8732e1d2-a7c0-45a3-b69b-7649b517cd5f
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
April 2014
West, M.A.
98b67e58-9875-4133-b236-8a10a0a12c04
Lythgoe, D.
123c3e46-3677-4588-a199-2f79e6e96d6f
Barben, C.P.
9ea1cefa-a22c-422c-b72d-24459c633d4f
Noble, L.
d552b08b-12a3-4187-90f5-78b53885348d
Kemp, G.J.
8732e1d2-a7c0-45a3-b69b-7649b517cd5f
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
West, M.A., Lythgoe, D., Barben, C.P., Noble, L., Kemp, G.J., Jack, S. and Grocott, M.P.W.
(2014)
Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study.
British Journal of Anaesthesia, 112 (4), .
(doi:10.1093/bja/aet408).
(PMID:24322573)
Abstract
BACKGROUND: Postoperative complications are associated with reduced fitness. Cardiopulmonary exercise testing (CPET) has been used in risk stratification. We investigated the relationship between preoperative CPET and in-hospital morbidity in major colonic surgery.
METHODS: We prospectively studied 198 patients undergoing major colonic surgery (excluding neoadjuvant cancer therapy), performing preoperative CPET (reported blind to clinical state), and recording morbidity (assessed blind to CPET), postoperative outcome, and length of stay.
RESULTS: Of 198 patients, 62 were excluded: 11 had emergency surgery, 25 had no surgery, 23 had incomplete data, and three were unable to perform CPET. One hundred and thirty-six (89 males, 47 females) were available for analysis. The median age was 71 [inter-quartile range (IQR) 62-77] yr. Sixty-five patients (48%) had a complication at day 5 after operation. Measurements significantly lower in patients with complications than those without were O2 uptake () at estimated lactate threshold () [median 9.9 (IQR 8.3-12.7) vs 11.2 (9.5-14.2) ml kg-1 min-1, P<0.01], at peak [15.2 (12.6-18.1) vs 17.2 (13.7-22.5) ml kg-1 min-1, P=0.01], and ventilatory equivalent for CO2 (/) at [31.3 (28.0-34.8) vs 33.9 (30.0-39.1), P<0.01]. A final multivariable logistic regression model contained at {one-point change odds ratio (OR) 0.77 [95% confidence interval (CI) 0.66-0.89], P<0.0005; two-point change OR 0.61 (0.46-0.81) and gender [OR 4.42 (1.78-9.88), P=0.001]}, and was reasonably able to discriminate those with and without complications (AUC 0.71, CI 0.62-0.80, 68% sensitivity, 65% specificity).
CONCLUSIONS: CPET variables are associated with postoperative morbidity. A multivariable model with at and gender discriminates those with complications after colonic surgery.
Text
Final manuscript BJA - with review comments v1
- Accepted Manuscript
More information
Accepted/In Press date: 10 September 2013
e-pub ahead of print date: 13 December 2013
Published date: April 2014
Keywords:
anaerobic threshold, cardiopulmonary exercise test, colorectal surgery, morbidity, postoperative complications
Organisations:
Clinical & Experimental Sciences
Identifiers
Local EPrints ID: 360528
URI: http://eprints.soton.ac.uk/id/eprint/360528
ISSN: 0007-0912
PURE UUID: 2d7238cd-34d2-4c74-8a25-31f7f969fc56
Catalogue record
Date deposited: 16 Dec 2013 09:52
Last modified: 15 Mar 2024 03:58
Export record
Altmetrics
Contributors
Author:
D. Lythgoe
Author:
C.P. Barben
Author:
L. Noble
Author:
G.J. Kemp
Author:
S. Jack
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
