Key result
Lower preoperative anaerobic threshold linked to postoperative cardiopulmonary complications, with ~6-point lower predicted VO2 max.
Why the study?
The ability of pulmonary function tests to predict postoperative cardiopulmonary complications prior to major surgery remains poorly defined.
Does preoperative cardiopulmonary exercise testing predict postoperative cardiopulmonary complications in patients undergoing major upper gastrointestinal surgery?
Cohort (n=193)
No
Does preoperative cardiopulmonary exercise testing predict postoperative cardiopulmonary complications in patients undergoing major upper gastrointestinal surgery?
p-value: p=0.020
Preoperative cardiopulmonary exercise testing, particularly anaerobic threshold, can help identify patients at high risk for cardiopulmonary complications following major upper gastrointestinal surgery.
Lower preoperative anaerobic threshold associated with cardiopulmonary complications after upper GI surgery; hypothesis-generating for CPET risk stratification, prospective validation needed.
Background: Assessment of patient’s fitness prior to major surgery is mandatory because co-morbidities predispose to postoperative complications; however the ability of pulmonary function tests to predict postoperative cardiopulmonary complications is still poorly defined. Objective: to examine the role of preoperative measurements of cardiopulmonary exercise testing and other lung function tests in predicting postoperative outcomes in patients undergoing major upper gastrointestinal surgery (stomach, oesophagus, small intestine, gall bladder and pancreas surgery). Patients and methods: A 193 patients who had major upper gastrointestinal surgery’ age, sex and smoking status were recorded and they underwent a range of tests including body mass index, flow-volume curve spirometry, blood gas analysis, transfer factor for carbon monoxide (TLCO) and CPET at the Pulmonary Function Laboratory of Glasgow Royal Infirmary between August 2008 and December 2011. Post-operative morbidity and mortality was analysed for all patients who underwent major surgery. Results: Comparisons between patients that did or did not have post operative pulmonary complications showed significant differences in anaerobic threshold as % predicted maximum oxygen consumption during exercise (VO2; p<0.05), length of high dependency care stay (p<0.001), length of ward stay (p<0.01) and length of hospital stay (p<0.001). There were significant differences between those patients with and without operative anastomotic leak in body mass index (BMI; p<0.05), length of high dependency care stay (p<0.001), length of ward stay (6 vs.15, respectively; p<0.001), length of hospital stay (14 vs. 28, respectively; p<0.001) and duration between date of surgery and date of commencing postoperative chemotherapy (p≤0.01). Conclusion: CPET and in particular anaerobic threshold % maximum predicted is useful in predicting the likelihood of the development of pulmonary complications in patients undergoing upper gastrointestinal surgery.
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Alrefaee et al. (2019) conducted a cohort in Major upper gastrointestinal surgery (n=193). Cardiopulmonary exercise testing (anaerobic threshold) vs. Patients without postoperative cardiopulmonary complications was evaluated on Postoperative cardiopulmonary complications at 30 days (p=0.020). Patients who developed postoperative cardiopulmonary complications had a significantly lower preoperative median anaerobic threshold (% predicted maximum VO2) compared to those who did not (41.4% vs 47.2%, p=0.020).
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