Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery. Issue 7 (21st May 2015)

• Record Type: Journal Article
• Authors: Kasivisvanathan, Ramanathan; Abbassi‐Ghadi, Nima; McLeod, Andrew D. M.; Oliver, Alex; Rao Baikady, Ravishankar; Jhanji, Shaman; Cone, Stephen; Wigmore, Timothy
• Is Part Of: HPB. Volume 17:Issue 7(2015:Jul.)
• Page Start: 637
• Page End: 643
• Publication Date: 2015-05-21
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12420
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main" id="hpb12420-abs-0001"> <title>Abstract</title> <sec id="hpb12420-sec-0001" sec-type="section"> <title>Objectives</title> <p>Cardiopulmonary exercise testing (CPET) may predict which patients are at risk for adverse outcomes after major abdominal surgery. The primary aim of this study was to determine whether CPET variables are predicative of morbidity.</p> </sec> <sec id="hpb12420-sec-0002" sec-type="section"> <title>Methods</title> <p>High‐risk patients undergoing elective, one‐stage, open hepatic resection were preoperatively assessed using CPET. Morbidity, as defined by the Postoperative Morbidity Survey (POMS), was assessed on postoperative day 3.</p> </sec> <sec id="hpb12420-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 104 patients underwent preoperative CPET and were included in the analysis. Of these, 73 patients (70.2%) experienced postoperative morbidity. Oxygen consumption at anaerobic threshold (<inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgjrmm57md" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:1365182X:media:hpb12420:hpb12420-math-0001" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msub><mml:mover accent="true"><mml:mi>V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:msub></mml:math></alternatives></inline-formula> at AT, ml/kg/min) was the only CPET predictor of postoperative morbidity on multivariable analysis, with an area under the curve (AUC) of 0.66 [95% confidence interval (CI) 0.55–0.76]. In patients requiring a major hepatic resection (three or more segments), a <inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgjrmm57kw" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:1365182X:media:hpb12420:hpb12420-math-0002" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msub><mml:mover accent="true"><mml:mi>V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:msub></mml:math></alternatives></inline-formula> at AT of <10.2 ml/kg/min gave an AUC of 0.79 (95% CI 0.68–0.86) with 83.9% sensitivity and 52.0% specificity, 80.6% positive predictive value and 62.5% negative predictive value.</p> </sec> <sec id="hpb12420-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The application of a cut‐off value for <inline-formula><alternatives><inline-graphic mimetype="image" xlink:href="ark:/27927/pgjrmm57jc" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="urn:x-wiley:1365182X:media:hpb12420:hpb12420-math-0003" overflow="scroll" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msub><mml:mover accent="true"><mml:mi>V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:msub></mml:math></alternatives></inline-formula> at AT of <10.2 ml/kg/min in patients undergoing major hepatic resection may be useful for predicting which patients will experience morbidity.</p> </sec> </abstract>