Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)
Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)
PURPOSE: This review evaluates the current and future role of cardiopulmonary exercise testing (CPET) in the context of Enhanced Recovery After Surgery (ERAS) programs.
PRINCIPAL FINDINGS: There is substantial literature confirming the relationship between physical fitness and perioperative outcome in general. The few small studies in patients undergoing surgery within an ERAS program describe less fit individuals having a greater incidence of morbidity and mortality. There is evidence of increasing adoption of perioperative CPET, particularly in the UK. Although CPET-derived variables have been used to guide clinical decisions about choice of surgical procedure and level of perioperative care as well as to screen for uncommon comorbidities, the ability of CPET-derived variables to guide therapy and thereby improve outcome remains uncertain. Recent studies have reported a reduction in CPET-defined physical fitness following neoadjuvant therapies (chemo- and radio-therapy) prior to surgery. Preliminary data suggest that this effect may be associated with an adverse effect on clinical outcomes in less fit patients. Early reports suggest that CPET-derived variables can be used to guide the prescription of exercise training interventions and thereby improve physical fitness in patients prior to surgery (i.e., prehabilitation). The impact of such interventions on clinical outcomes remains uncertain.
CONCLUSIONS:Perioperative CPET is finding an increasing spectrum of roles, including risk evaluation, collaborative decision-making, personalized care, monitoring interventions, and guiding prescription of prehabilitation. These indications are potentially of importance to patients having surgery within an ERAS program, but there are currently few publications specific to CPET in the context of ERAS programs
131-142
Levett, D.Z.
812d6450-bafe-42f6-a0b1-5093c838b1e9
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
February 2015
Levett, D.Z.
812d6450-bafe-42f6-a0b1-5093c838b1e9
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Levett, D.Z. and Grocott, Michael P.W.
(2015)
Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS).
Canadian Journal of Anesthesia, 62 (2), .
(doi:10.1007/s12630-014-0307-6).
(PMID:25608638)
Abstract
PURPOSE: This review evaluates the current and future role of cardiopulmonary exercise testing (CPET) in the context of Enhanced Recovery After Surgery (ERAS) programs.
PRINCIPAL FINDINGS: There is substantial literature confirming the relationship between physical fitness and perioperative outcome in general. The few small studies in patients undergoing surgery within an ERAS program describe less fit individuals having a greater incidence of morbidity and mortality. There is evidence of increasing adoption of perioperative CPET, particularly in the UK. Although CPET-derived variables have been used to guide clinical decisions about choice of surgical procedure and level of perioperative care as well as to screen for uncommon comorbidities, the ability of CPET-derived variables to guide therapy and thereby improve outcome remains uncertain. Recent studies have reported a reduction in CPET-defined physical fitness following neoadjuvant therapies (chemo- and radio-therapy) prior to surgery. Preliminary data suggest that this effect may be associated with an adverse effect on clinical outcomes in less fit patients. Early reports suggest that CPET-derived variables can be used to guide the prescription of exercise training interventions and thereby improve physical fitness in patients prior to surgery (i.e., prehabilitation). The impact of such interventions on clinical outcomes remains uncertain.
CONCLUSIONS:Perioperative CPET is finding an increasing spectrum of roles, including risk evaluation, collaborative decision-making, personalized care, monitoring interventions, and guiding prescription of prehabilitation. These indications are potentially of importance to patients having surgery within an ERAS program, but there are currently few publications specific to CPET in the context of ERAS programs
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Accepted/In Press date: 28 October 2014
e-pub ahead of print date: 22 January 2015
Published date: February 2015
Organisations:
NIHR Southampton Respiratory Biomedical Research Unit
Identifiers
Local EPrints ID: 384048
URI: http://eprints.soton.ac.uk/id/eprint/384048
ISSN: 0832-610X
PURE UUID: fbd10ef6-00ac-4919-9f86-a750c3d82d1f
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Date deposited: 08 Dec 2015 13:22
Last modified: 15 Mar 2024 03:33
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D.Z. Levett
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