Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study

Abstract

CPET variables are associated with postoperative morbidity. A multivariable model with VO₂ at θ(L) and gender discriminates those with complications after colonic surgery.

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

“…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. 38 The 2014 American College of Cardiology/AHA guidelines on the perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery also give CPX a Class IIb (Level of Evidence B) rating.…”

Systematic review of pre-operative exercise in colorectal cancer patients

“…The time pressure experienced in the UK and internationally may well contribute to the lack of quality research and subsequent evidence base supporting the use of exercise treatments in the period between decision to treat and surgery for colorectal cancer. Given however, that recent work has shown that those with improved cardio-respiratory fitness have lower rates of mortality and complications following colorectal cancer surgery [8,9], this time period provides an opportunity to attempt to improve cardio-respiratory fitness before surgery, with the possibility of reducing peri-operative risk and improving post-operative outcome.…”

Comparaison des méthodes de détermination des seuils ventilatoires: implications pour la stratification du risque chirurgical

“…19,39 In practical terms, this degree of variability is potentially significant when considering outcomes in perioperative assessments. 5,11,13,15,22,[39][40][41] In two recent reviews, Levett et al 5,12 summarized studies assessing the association between preoperative VT and postoperative outcomes. These studies among different surgery candidates (including major intra-abdominal, colon, rectal, hepatobiliary, hepatic resection, liver transplant, upper gastrointestinal, bariatric, cystectomy, and AAA repair procedures) showed that values below 9-12 mLO 2 Ákg -1…”

“…5,6,[8][9][10][11][12] Ventilatory threshold values were associated with morbidity, mortality, surgery complications, and length of hospital stay. 5,[12][13][14][15][16][17] The VT is defined as an exercise intensity beyond which the increase in ventilation becomes disproportionate to the increase in power output or oxygen uptake during progressive exercise. 11,18 This measure provides important information regarding the major physiological systems involved in aerobic exercise and constitutes a determinant of an individual's functional capabilities and cardiorespiratory performance.…”

“…22 Given the caveats related to determining the VT, guidelines on CPET suggest confirming the VT visually using one of several methods. 6,8,9 Because the VT has been increasingly applied to assess surgical outcomes, 5,[12][13][14][15][16][17]23 a reliable determination of this point is critically important in evaluating perioperative prognosis. In the current study, we sought to quantify agreement between methods of determining the VT. We compared visual readings by experienced reviewers, automated determination by a metabolic system, and the application of a computer-derived program (developed by the authors) which employs the point with the least mean square error of the fit between the log of oxygen uptake and the log of ventilation.…”