Cardiopulmonary exercise testing before liver surgery. Issue 4 (4th June 2014)

• Record Type: Journal Article
• Authors: Dunne, Declan F.J.; Jones, Robert P.; Lythgoe, Daniel T.; Pilkington, Francis J.; Palmer, Daniel H.; Malik, Hassan Z.; Poston, Graeme J.; Lacasia, Carmen; Jack, Sandy; Fenwick, Stephen W.
• Is Part Of: Journal of surgical oncology. Volume 110:Issue 4(2014:Sep. 15)
• Page Start: 439
• Page End: 444
• Publication Date: 2014-06-04
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23670
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jso23670-sec-0001" sec-type="section"> <title>Background</title> <p>Cardiopulmonary exercise testing (CPET) assessed "poorer" fitness correlates with poorer outcomes in blinded studies. Whether this correlation will persist when CPET is utilized to stratify care as part of a multi‐modal enhanced recovery after surgery (ERAS) program is unclear. This study examined whether CPET variables were associated with postoperative morbidity in patients undergoing hepatectomy within an ERAS program.</p> </sec> <sec id="jso23670-sec-0002" sec-type="section"> <title>Objectives and Methods</title> <p>Data were prospectively collected on patients undergoing elective hepatectomy between October 2009 and April 2011. The relationships between CPET derived variables; postoperative complications and length of stay were investigated.</p> </sec> <sec id="jso23670-sec-0003" sec-type="section"> <title>Results</title> <p>Of 267 patients undergoing surgery, 197 had undergone standard cycle ergometer CPET. The relative oxygen uptake [<inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pghzffnzx8" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:00224790:media:jso23670:jso23670-math-0001" display="inline" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msub><mml:mi mathvariant="normal">V</mml:mi><mml:mrow><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:msub></mml:mrow></mml:math></alternatives></inline-formula> (ml kg<sup>−1</sup> min<sup>−1</sup>)] and ventilatory equivalent of CO<sub>2</sub><inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pghzffnzs6" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:00224790:media:jso23670:jso23670-math-0002" display="inline" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:msub><mml:mi mathvariant="normal">V</mml:mi><mml:mi mathvariant="normal">E</mml:mi></mml:msub><mml:mtext>/</mml:mtext><mml:msub><mml:mi mathvariant="normal">V</mml:mi><mml:mrow><mml:mi mathvariant="normal">C</mml:mi><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:msub><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:math></alternatives></inline-formula> at the anaerobic threshold (AT) were not associated with complications or length of stay. Greater absolute oxygen uptake at AT [<inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pghzffnzrp" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:00224790:media:jso23670:jso23670-math-0003" display="inline" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msub><mml:mi mathvariant="normal">V</mml:mi><mml:mrow><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:msub></mml:mrow></mml:math></alternatives></inline-formula> at AT (L min<sup>−1</sup>)] was associated with early hospital discharge [OR 2.16 (95% CI 1.18–3.96), <italic>P</italic> = 0.013] on multivariable analysis.</p> </sec> <sec id="jso23670-sec-0004" sec-type="section"> <title>Conclusions</title> <p>When CPET is used to delineate perioperative management a low relative oxygen uptake [<inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pghzffnzv7" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:00224790:media:jso23670:jso23670-math-0004" display="inline" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msub><mml:mi mathvariant="normal">V</mml:mi><mml:mrow><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:msub></mml:mrow></mml:math></alternatives></inline-formula> (ml kg<sup>−1</sup> min<sup>−1</sup>)] at the AT does not place patients at significantly higher risk of postoperative complications. This suggests CPET assessed "poor" fitness should not be used as a barrier to surgical intervention. <italic>J. Surg. Oncol. 2014; 110:439–444</italic>. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>