Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study


West, M.A., Lythgoe, D., Barben, C.P., Noble, L., Kemp, G.J., Jack, S. and Grocott, M.P.W. (2013) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study British Journal of Anaesthesia (doi:10.1093/bja/aet408). (PMID:24322573).

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Description/Abstract

BACKGROUND: /st>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: /st>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: /st>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: /st>CPET variables are associated with postoperative morbidity. A multivariable model with at and gender discriminates those with complications after colonic surgery.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1093/bja/aet408
ISSNs: 0007-0912 (print)
Keywords: anaerobic threshold, cardiopulmonary exercise test, colorectal surgery, morbidity, postoperative complications
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RD Surgery
Organisations: Clinical & Experimental Sciences
ePrint ID: 360528
Date :
Date Event
8 December 2013Published
Date Deposited: 16 Dec 2013 09:52
Last Modified: 17 Apr 2017 14:30
Further Information:Google Scholar
URI: http://eprints.soton.ac.uk/id/eprint/360528

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