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Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery

Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery
Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery
BACKGROUND: In single-centre studies, postoperative complications are associated with reduced fitness. This study explored the relationship between cardiorespiratory fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after major elective colorectal surgery.

METHODS: Patients underwent preoperative CPET with recording of in-hospital morbidity. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.

RESULTS: Seven hundred and three patients from six centres in the UK were available for analysis (428 men, 275 women). ROC curve analysis of oxygen uptake at estimated lactate threshold (V?o2 at ?^L ) and at peak exercise (V?o2peak ) gave an area under the ROC curve (AUROC) of 0·79 (95 per cent c.i. 0·76 to 0·83; P < 0·001; cut-off 11·1 ml per kg per min) and 0·77 (0·72 to 0·82; P < 0·001; cut-off 18·2 ml per kg per min) respectively, indicating that they can identify patients at risk of postoperative morbidity. In a multivariable logistic regression model, selected CPET variables and body mass index (BMI) were associated significantly with increased odds of in-hospital morbidity (V?o2 at ?^L 11·1 ml per kg per min or less: odds ratio (OR) 7·56, 95 per cent c.i. 4·44 to 12·86, P < 0·001; V?o2peak 18·2 ml per kg per min or less: OR 2·15, 1·01 to 4·57, P = 0·047; ventilatory equivalents for carbon dioxide at estimated lactate threshold (V?E /V?co2 at ?^L ) more than 30·9: OR 1·38, 1·00 to 1·89, P = 0·047); BMI exceeding 27 kg/m2 : OR 1·05, 1·03 to 1·08, P < 0·001). A laparoscopic procedure was associated with a decreased odds of complications (OR 0·30, 0·02 to 0·44; P = 0·033). This model was able to discriminate between patients with, and without in-hospital morbidity (AUROC 0·83, 95 per cent c.i. 0·79 to 0·87). No adverse clinical events occurred during CPET across the six centres.

CONCLUSION: These data provide further evidence that variables derived from preoperative CPET can be used to assess risk before elective colorectal surgery.
1-9
West, M.A.
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Asher, R.
ec020c38-e813-4283-85a7-c24c12acda80
Browning, M.
5e31922b-2a63-45e4-82f4-ea64d4efb720
Minto, G.
0fe42e14-1a3c-49ad-87f0-c425eb88b20c
Swart, M.
1ffd3113-4b63-4f83-87b1-921e12ab3505
Richardson, K.
b6839895-a5fd-4dfa-9122-4b06b50cee1a
McGarrity, L.
f98507ef-7f8b-454c-ae2b-7edc08de4af0
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
West, M.A.
2214e590-8dc5-4ef4-9c9e-6491ff6cbc70
Asher, R.
ec020c38-e813-4283-85a7-c24c12acda80
Browning, M.
5e31922b-2a63-45e4-82f4-ea64d4efb720
Minto, G.
0fe42e14-1a3c-49ad-87f0-c425eb88b20c
Swart, M.
1ffd3113-4b63-4f83-87b1-921e12ab3505
Richardson, K.
b6839895-a5fd-4dfa-9122-4b06b50cee1a
McGarrity, L.
f98507ef-7f8b-454c-ae2b-7edc08de4af0
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2

West, M.A., Asher, R., Browning, M., Minto, G., Swart, M., Richardson, K., McGarrity, L., Jack, S. and Grocott, M.P.W. (2016) Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery British Journal of Surgery, pp. 1-9. (doi:10.1002/bjs.10112). (PMID:26914526).

Record type: Article

Abstract

BACKGROUND: In single-centre studies, postoperative complications are associated with reduced fitness. This study explored the relationship between cardiorespiratory fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after major elective colorectal surgery.

METHODS: Patients underwent preoperative CPET with recording of in-hospital morbidity. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.

RESULTS: Seven hundred and three patients from six centres in the UK were available for analysis (428 men, 275 women). ROC curve analysis of oxygen uptake at estimated lactate threshold (V?o2 at ?^L ) and at peak exercise (V?o2peak ) gave an area under the ROC curve (AUROC) of 0·79 (95 per cent c.i. 0·76 to 0·83; P < 0·001; cut-off 11·1 ml per kg per min) and 0·77 (0·72 to 0·82; P < 0·001; cut-off 18·2 ml per kg per min) respectively, indicating that they can identify patients at risk of postoperative morbidity. In a multivariable logistic regression model, selected CPET variables and body mass index (BMI) were associated significantly with increased odds of in-hospital morbidity (V?o2 at ?^L 11·1 ml per kg per min or less: odds ratio (OR) 7·56, 95 per cent c.i. 4·44 to 12·86, P < 0·001; V?o2peak 18·2 ml per kg per min or less: OR 2·15, 1·01 to 4·57, P = 0·047; ventilatory equivalents for carbon dioxide at estimated lactate threshold (V?E /V?co2 at ?^L ) more than 30·9: OR 1·38, 1·00 to 1·89, P = 0·047); BMI exceeding 27 kg/m2 : OR 1·05, 1·03 to 1·08, P < 0·001). A laparoscopic procedure was associated with a decreased odds of complications (OR 0·30, 0·02 to 0·44; P = 0·033). This model was able to discriminate between patients with, and without in-hospital morbidity (AUROC 0·83, 95 per cent c.i. 0·79 to 0·87). No adverse clinical events occurred during CPET across the six centres.

CONCLUSION: These data provide further evidence that variables derived from preoperative CPET can be used to assess risk before elective colorectal surgery.

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More information

Accepted/In Press date: 16 December 2015
Published date: 23 February 2016
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 389816
URI: http://eprints.soton.ac.uk/id/eprint/389816
PURE UUID: c8fa1d0b-ecd7-4fc4-800f-530535427432

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Date deposited: 16 Mar 2016 08:57
Last modified: 17 Jul 2017 19:31

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Contributors

Author: M.A. West
Author: R. Asher
Author: M. Browning
Author: G. Minto
Author: M. Swart
Author: K. Richardson
Author: L. McGarrity
Author: S. Jack
Author: M.P.W. Grocott

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