[A6 Cardiopulmonary exercise testing for collaborative decision making prior to major hepatobiliary surgery] Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

Edwards, Mark, Sharp, Thomas, Jack, Sandy, Armstrong, Tom, Primrose, John, Grocott, Michael and Levett, Denny (2016) [A6 Cardiopulmonary exercise testing for collaborative decision making prior to major hepatobiliary surgery] Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine. Perioperative Medicine, 5 (S1). (doi:10.1186/s13741-016-0045-0).

Abstract

Background/Introduction: Cardiopulmonary exercise testing (CPET) is increasingly used for preoperative risk assessment. Evidence to date suggests utility for predicting risk of postoperative morbidity and mortality across a number of surgical specialties (1). It is commonly used to triage patients to postoperative critical care (2) and to inform preoperative risk discussions. We report its use for preoperative collaborative decision making in a large University hepatopancreatobiliary (HPB) surgical unit in which postoperative critical care admission is routine. Methods: Patients undergoing assessment for liver resection and pancreaticoduodenectomy in 2014 and 2015 underwent symptom limited incremental exercise testing at the surgeons’ discretion. Data collected included anaerobic threshold (AT), peak oxygen consumption (peakVO2) and ventilatory equivalents for carbon dioxide at AT (VE/VCO2), clinical plan made on the basis of CPET, intensive care and hospital length of stay (LOS) in operated patients. Based on prior literature, physiological risk was reported to the clinical team as “low risk” (AT > 10mlO2.min-1.kg-1), “high risk” (AT 8-10mlO2.min-1.kg-1) or “very high risk” (AT

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Contributors

Author: John Primrose

Author: Michael Grocott

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