Key result
Low early-exercise end-tidal CO2 linked to ~88% lower two-year survival odds and severe postoperative complications.
Why the study?
CPET facilities are resource intensive, making more cost-effective triage methods desirable for scalability prior to major surgery.
Do early phase exercise PetCO2 and resting DLCO predict postoperative complications and survival in patients undergoing major abdominal cancer surgery?
Cohort (n=84)
Do early phase exercise PetCO2 and resting DLCO predict postoperative complications and survival in patients undergoing major abdominal cancer surgery?
Effect estimate: OR 0.12 (95% CI 0.03-0.47)
p-value: p=0.003
Assessment of resting DLCO and early phase exercise PetCO2 may serve as effective, inexpensive point-of-care triage tools for preoperative risk stratification prior to major abdominal surgery.
Low early-exercise PetCO2 may aid preoperative risk stratification in abdominal cancer surgery; hypothesis-generating and requires prospective validation.
BACKGROUND: Cardiopulmonary exercise testing (CPET) objectively informs preoperative risk stratification prior to major surgery. CPET facilities are resource intensive and therefore more cost-effective triage methods are desirable for scalability. We tested two dynamic CPET parameters (end-tidal CO<inf>2</inf> (P<inf>et</inf>CO<inf>2</inf>) and heart rate (HR)) to early phase exercise and resting diffusion capacity (DLCO) as potential point of care assessments that could be used outside of formal CPET testing facilities. METHODS: We conducted a retrospective cohort study including 84 patients who underwent CPET prior to elective major abdominal cancer surgery. Data were analyzed for P<inf>et</inf>CO<inf>2</inf> and HR in response to early phase (2 minutes) exercise as well as resting DLCO against postoperative complications and two-year survival. Complications were classified according to Clavien-Dindo classification into less severe and severe (CD>IIIb) grades. Optimal cut points for predicting outcomes were determined using the Youden Index of receiver operating characteristic (ROC) curves. Multivariate regression modeling including both logistic and Cox proportional-hazards model adjusted to age and comorbidity burden was used to analyse the association between the selected parameters and postoperative outcomes. RESULTS: P<inf>et</inf>CO<inf>2</inf>, in response to two minutes of loaded exercise was higher in survivors than in non-survivors (median (IQR) 40.0 (4.2) mmHg vs. 34.5 (5.2) mmHg, P<0.001). There was no association between chronotropic response and postoperative outcome. The optimal cut point for predicting postoperative complications and survival was 38 mmHg and 37.1 mmHg for P<inf>et</inf>CO<inf>2</inf>, respectively. Low P<inf>et</inf>CO<inf>2</inf> was associated with considerably lower odds of survival (OR 0.12; 95% CI 0.03, 0.47; P=0.003) and additionally increased odds of severe postoperative complications (OR 6.77; 95% CI 1.45, 38.4; P=0.019). Reduced age-predicted DLCO% <80% was associated with increased mortality (HR 5.27; 95% CI 1.09, 25.5; P=0.039). CONCLUSIONS: Assessment of DLCO at rest and dynamic assessment of P<inf>et</inf>CO<inf>2</inf> during the early phase of exercise may potentially be developed as inexpensive point-of-care triage tools to scale objective preoperative risk assessment.
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ALFITIAN et al. (2022) conducted a cohort in Major abdominal cancer (n=84). End-tidal CO2 (PetCO2) during early phase exercise was evaluated on Two-year survival (OR 0.12, 95% CI 0.03-0.47, p=0.003). Low end-tidal CO2 during early phase exercise was associated with lower odds of two-year survival (OR 0.12; 95% CI 0.03-0.47; P=0.003) and increased severe postoperative complications.
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