Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery

Kasivisvanathan, Ramanathan; Abbassi‐Ghadi, Nima; McLeod, Andrew; Oliver, Alex; Baikady, Ravishankar Rao; Jhanji, Shaman; Cone, Stephen; Wigmore, Timothy

doi:10.1111/hpb.12420

Cited by 23 publications

(25 citation statements)

References 22 publications

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“…18-21 Surgical procedures in which CPX has demonstrated prognostic value include abdominal aortic aneurysm repair, [22][23][24][25] radical cystectomy, 26 liver transplantation, 27 hepatic resection, 28 lung resection, [29][30][31][32][33] bariatric surgery, 34,35 and colorectal surgery. 36,37 In fact, the American College of Chest Physicians clinical practice guidelines for evaluation procedures of patients with lung cancer being considered for surgical resection recommend the use of CPX to assess risk.…”

Section: Cpx To Assess Perisurgical and Postsurgical Risk And Long-tementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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Abstract-In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. (Circulation. 2016;133:e694-e711.

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Section: Cpx To Assess Perisurgical and Postsurgical Risk And Long-tementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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“…One hundred and eight studies were identified using the search terms, of which 7 were considered relevant based on their title. These were reduced to 4 after reading the abstracts and 3 met the inclusion criteria and were included in this review (21)(22)(23). All 3 were UK hospital-based cohort investigations (2 prospective and 1 retro- spective) of patients that underwent both major and minor hepatectomies (21)(22)(23).…”

Section: Liver Cancermentioning

confidence: 99%

“…These were reduced to 4 after reading the abstracts and 3 met the inclusion criteria and were included in this review (21)(22)(23). All 3 were UK hospital-based cohort investigations (2 prospective and 1 retro- spective) of patients that underwent both major and minor hepatectomies (21)(22)(23). The largest, a retrospective study of 197 patients, found no association between in-hospital morbidity and VO2peak or AT (22).…”

Section: Liver Cancermentioning

confidence: 99%

Cardiopulmonary Exercise Testing for Predicting Early Outcomes after Major Cancer Resection: A Systematic Review

Lam¹,

Hart²

2018

J Anesth Perioper Med

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Background: Postoperative complications after major surgery are thought to be associated with reduced fitness. Surgical cancer patients are often malnourished, cachexic and subject to neoadjuvant chemotherapy resulting in low preoperative fitness levels. This review examined the associations between aerobic fitness, as determined objectively by preoperative cardiopulmonary exercise testing (CPEX), and short-term morbidity after cancer surgery. Methods: A literature search using databases of PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Library for studies that examined associations between preoperative CPEX variables and postoperative complications following surgery for the ten commonest cancers. Results: A total of 21 observational studies were identified with 4957 patients that underwent CPEX testing prior to lung, colorectal, liver, oesophagogastric, bladder and pancreas resections. The median sample size was 105 patients (range 64 -1684). No studies were found for breast or brain cancers or lymphoma. In lung cancer patients undergoing thoracotomy, a VO2peak ≤ 15ml/kg/min was associated with an increased risk of respiratory complications and death. None of the studies in other cancer types had adequate sample sizes to report on mortality. CPEX testing had mostly poor to average discriminatory accuracy to predict postoperative morbidity in other cancer resection surgeries. Findings across studies were inconsistent, and detection and selective reporting biases were likely to be significant. Conclusion: The utility of CPEX testing prior to cancer surgery is questionable and currently should not be used as a discriminatory tool, except in patients undergoing lung cancer resection by thoracotomy. Larger studies with more robust methodologies are currently required to determine the utility of CPEX.

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“…morbidity, mortality, length of stay) [1][2][3][4][5][6][7][8][9][10][11][12]. Similar to immunological and neuroendocrine reserve, cardiorespiratory fitness indicates the physiological reserve capacity of the patient to maintain homeostasis with adequate responses to allostatic load (allostasis).…”

Section: Introductionmentioning

confidence: 99%

“…Pre-operative cardiorespiratory fitness has been found to have a consistent relation with postoperative outcome indicators in major elective abdominal surgery (e.g. morbidity, mortality, length of stay) [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

et al. 2017

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This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg .min , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg .min , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.

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Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery

Abstract: The application of a cut-off value for V˙O2 at AT of <10.2 ml/kg/min in patients undergoing major hepatic resection may be useful for predicting which patients will experience morbidity.

Cited by 23 publications

References 22 publications

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

Cardiopulmonary Exercise Testing for Predicting Early Outcomes after Major Cancer Resection: A Systematic Review

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

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