PMID- 24322573
OWN - NLM
STAT- MEDLINE
DCOM- 20140508
LR  - 20220318
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 112
IP  - 4
DP  - 2014 Apr
TI  - Cardiopulmonary exercise variables are associated with postoperative morbidity 
      after major colonic surgery: a prospective blinded observational study.
PG  - 665-71
LID - 10.1093/bja/aet408 [doi]
AB  - BACKGROUND: Postoperative complications are associated with reduced fitness. 
      Cardiopulmonary exercise testing (CPET) has been used in risk stratification. We 
      investigated the relationship between preoperative CPET and in-hospital morbidity 
      in major colonic surgery. METHODS: We prospectively studied 198 patients 
      undergoing major colonic surgery (excluding neoadjuvant cancer therapy), 
      performing preoperative CPET (reported blind to clinical state), and recording 
      morbidity (assessed blind to CPET), postoperative outcome, and length of stay. 
      RESULTS: Of 198 patients, 62 were excluded: 11 had emergency surgery, 25 had no 
      surgery, 23 had incomplete data, and three were unable to perform CPET. One 
      hundred and thirty-six (89 males, 47 females) were available for analysis. The 
      median age was 71 [inter-quartile range (IQR) 62-77] yr. Sixty-five patients 
      (48%) had a complication at day 5 after operation. Measurements significantly 
      lower in patients with complications than those without were O2 uptake (VO(2)) at 
      estimated lactate threshold (theta(L)) [median 9.9 (IQR 8.3-12.7) vs 11.2 (9.5-14.2) 
      ml kg(-1) min(-1), P<0.01], VO(2) at peak [15.2 (12.6-18.1) vs 17.2 (13.7-22.5) ml 
      kg(-1) min(-1), P=0.01], and ventilatory equivalent for CO2 (V(E)/VCO(2)) at theta(L) 
      [31.3 (28.0-34.8) vs 33.9 (30.0-39.1), P<0.01]. A final multivariable logistic 
      regression model contained VO(2) at theta(L) one-point change odds ratio (OR) 0.77 
      [95% confidence interval (CI) 0.66-0.89], P<0.0005; two-point change OR 0.61 
      (0.46-0.81) and gender [OR 4.42 (1.78-9.88), P=0.001], and was reasonably able 
      to discriminate those with and without complications (AUC 0.71, CI 0.62-0.80, 68% 
      sensitivity, 65% specificity). CONCLUSIONS: CPET variables are associated with 
      postoperative morbidity. A multivariable model with VO(2) at theta(L) and gender 
      discriminates those with complications after colonic surgery.
FAU - West, M A
AU  - West MA
AD  - Colorectal Surgery Research Group, 3rd Floor Clinical Sciences Building, Aintree 
      University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK.
FAU - Lythgoe, D
AU  - Lythgoe D
FAU - Barben, C P
AU  - Barben CP
FAU - Noble, L
AU  - Noble L
FAU - Kemp, G J
AU  - Kemp GJ
FAU - Jack, S
AU  - Jack S
FAU - Grocott, M P W
AU  - Grocott MP
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20131208
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Aged
MH  - Anaerobic Threshold/physiology
MH  - Colon/*surgery
MH  - Exercise Test/*methods
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Oxygen Consumption/physiology
MH  - *Postoperative Complications
MH  - Preoperative Care/*methods
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Assessment/methods
MH  - Single-Blind Method
OTO - NOTNLM
OT  - anaerobic threshold
OT  - cardiopulmonary exercise test
OT  - colorectal surgery
OT  - morbidity
OT  - postoperative complications
EDAT- 2013/12/11 06:00
MHDA- 2014/05/09 06:00
CRDT- 2013/12/11 06:00
PHST- 2013/12/11 06:00 [entrez]
PHST- 2013/12/11 06:00 [pubmed]
PHST- 2014/05/09 06:00 [medline]
AID - S0007-0912(17)30881-4 [pii]
AID - 10.1093/bja/aet408 [doi]
PST - ppublish
SO  - Br J Anaesth. 2014 Apr;112(4):665-71. doi: 10.1093/bja/aet408. Epub 2013 Dec 8.