Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study

Gooneratne, Mevan; McNeill, J.; Lee, Aaron M.; Levett, Denny; Grocott, Michael P.W.; Swart, Michael; MacDonald, Neil; Abbott, Tom; Raj, Ashok; Rooms, Martin; Nicol, M F; Koutra, Maria; Halworth, S.; Wilkins, Kirsten M.; Nevin, D.; Gaultry, E.; Otto, James; Bell, David; Hardy, Myra; Prabhu, Pradeep; Ravishankar, Reddy; Correia, J; Beilstein, Christian M.; Greaves, Kathryn; James, S. Jill; Tighe, Hannah; Perks, J; Pennington, James; Pritchard, Angus; Moxon, P.; Brown, Katherine; Carlisle, J. B.

doi:10.1016/j.bja.2017.11.071

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…A sample size calculation was performed using the sampicc function in STATA statistical software. Based on a previous study of Abbott et al, the estimated intraclass correlation coefficient (ICC) was 0.83 for V̇O 2VAT and 0.88 for V̇O 2peak [ 13 ]. It was hypothesized that the ICC values for the V̇E/V̇CO 2 -slope and OUES would be markedly higher, as interpretation of these parameters is less complex.…”

Section: Methodsmentioning

confidence: 99%

“…Methods of determining the submaximal V̇O 2VAT are complex [ 12 ] and there remains controversy about the underlying physiology of the V̇O 2VAT [ 12 ]. A previous study has shown that the V̇O 2VAT is not determinable in approximately 16% of the preoperative CPETs [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although there is some research investigating the inter-observer agreement of the V̇O 2VAT and the V̇O 2peak in preoperative CPET [ 13 ], data on the inter-observer agreement of the preoperative V̇E/V̇CO 2 -slope and OUES are lacking. In addition, it is unknown whether uniformity in determination of CPET-derived parameters can be improved by using a set of guidelines for CPET interpretation.…”

Section: Introductionmentioning

confidence: 99%

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Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Franssen

Eversdijk

Kuikhoven³

et al. 2022

BMC Anesthesiol

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Background Accurate determination of cardiopulmonary exercise test (CPET) derived parameters is essential to allow for uniform preoperative risk assessment. The objective of this prospective observational study was to evaluate the inter-observer agreement of preoperative CPET-derived variables by comparing a self-preferred approach with a systematic guideline-based approach. Methods Twenty-six professionals from multiple centers across the Netherlands interpreted 12 preoperative CPETs of patients scheduled for hepatopancreatobiliary surgery. Outcome parameters of interest were oxygen uptake at the ventilatory anaerobic threshold (V̇O2VAT) and at peak exercise (V̇O2peak), the slope of the relationship between the minute ventilation and carbon dioxide production (V̇E/V̇CO2-slope), and the oxygen uptake efficiency slope (OUES). Inter-observer agreement of the self-preferred approach and the guideline-based approach was quantified by means of the intra-class correlation coefficient. Results Across the complete cohort, inter-observer agreement intraclass correlation coefficient (ICC) was 0.76 (95% confidence interval (CI) 0.57–0.93) for V̇O2VAT, 0.98 (95% CI 0.95–0.99) for V̇O2peak, and 0.86 (95% CI 0.75–0.95) for the V̇E/V̇CO2-slope when using the self-preferred approach. By using a systematic guideline-based approach, ICCs were 0.88 (95% CI 0.74–0.97) for V̇O2VAT, 0.99 (95% CI 0.99–1.00) for V̇O2peak, 0.97 (95% CI 0.94–0.99) for the V̇E/V̇CO2-slope, and 0.98 (95% CI 0.96–0.99) for the OUES. Conclusions Inter-observer agreement of numerical values of CPET-derived parameters can be improved by using a systematic guideline-based approach. Effort-independent variables such as the V̇E/V̇CO2-slope and the OUES might be useful to further improve uniformity in preoperative risk assessment in addition to, or in case V̇O2VAT and V̇O2peak are not determinable.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Franssen

Eversdijk

Kuikhoven³

et al. 2022

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Second, the intraclass correlation coefficient (ICC) was used with a two‐way random‐effects model for absolute agreement, to measure the reliability of assignment of complication severity between the classification systems. This method is commonly used to compare the reliability of diagnostic tests. The ICC was calculated for the whole sample, and repeated after stratifying the sample by complication type.…”

Section: Methodsmentioning

confidence: 99%

“…The results are presented as ICC with 95 per cent confidence intervals. An ICC of zero suggests no agreement between classification systems, and an ICC of 1 suggests complete agreement. ICC values were interpreted based on the schema presented by Koo and Li: more than 0·90, excellent; 0·76–0·90, good; 0·50–0·75, moderate; less than 0·5, poor.…”

Section: Methodsmentioning

confidence: 99%

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Abbott

Greaves

Patel

et al. 2019

British Journal of Surgery

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Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.

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A retrospective analysis of the association of effort-independent cardiopulmonary exercise test variables with postoperative complications in patients who underwent elective colorectal surgery

Franssen,

Berkel,

ten Cate

et al. 2023

Langenbecks Arch Surg

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Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study

Abstract: Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.

Cited by 8 publications

References 33 publications

Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

A retrospective analysis of the association of effort-independent cardiopulmonary exercise test variables with postoperative complications in patients who underwent elective colorectal surgery

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