Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery

West, Malcolm; Asher, Rebecca; Browning, Michael; Minto, Gary; Swart, Michael; Richardson, Karl; McGarrity, Larissa A.; Jack, Sandy; Grocott, Michael P.W.

doi:10.1002/bjs.10112

Cited by 123 publications

(112 citation statements)

References 30 publications

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“…These issues affect statistical analysis and generalisability, as does the fact that the thresholds for risk of the peak oxygen uptake and ventilatory anaerobic threshold were based on the cut-off points described in another study and patient population [12]. Firstly, due to the retrospective evaluation of the tests, there is a possibility of bias.…”

Section: Discussionmentioning

confidence: 99%

“…These peak oxygen uptake and ventilatory anaerobic threshold values are based on the cut-off points described by West et al [12]. Tests for normality were performed with the Shapiro-Wilk test.…”

Section: Methodsmentioning

confidence: 99%

“…morbidity, mortality, length of stay) [1][2][3][4][5][6][7][8][9][10][11][12]. Similar to immunological and neuroendocrine reserve, cardiorespiratory fitness indicates the physiological reserve capacity of the patient to maintain homeostasis with adequate responses to allostatic load (allostasis).…”

Section: Introductionmentioning

confidence: 99%

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An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

et al. 2017

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This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg .min , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg .min , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

et al. 2017

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“…The ability of CPET to identify patients at risk of poor outcomes is used clinically to guide perioperative care and clinical decision making, and it informs about the shared decision‐making process . We have previously reported that selected CPET variables such as oxygen uptake at estimated lactate threshold or anaerobic threshold (

\overset{V}{true}

O 2 at AT) and at peak exercise (

\overset{V}{true}

O 2 peak) are associated with worse outcome following colorectal surgery and neoadjuvant cancer treatments . Poor physical fitness is highly prevalent in HPB cancer patients and associated with poor post‐operative outcomes and survival …”

Section: Introductionmentioning

confidence: 99%

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

West

Dijk

Gleadowe

et al. 2019

J cachexia sarcopenia muscle

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Background Body composition assessment, measured using single‐slice computed tomography (CT) image at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Sarcopenia (i.e. low skeletal muscle mass), myosteatosis [i.e. low skeletal muscle radiation attenuation (SM‐RA)], and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post‐operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreatic surgery. Methods A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreatic surgery were recruited. All patients underwent preoperative CPET. Preoperative CT scans were analysed using a single‐slice CT image at L3 level to assess skeletal muscle mass, adipose tissue mass, and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold ( O 2 at AT), oxygen uptake at peak exercise ( O 2 peak), skeletal muscle mass, and SM‐RA. Results Of 123 patients recruited [77 men (63%), median age 66.9 ± 11.7, median body mass index 27.3 ± 5.2], 113 patients had good‐quality abdominal CT scans available and were included. Of the CT body composition variables, SM‐RA had the strongest correlation with O 2 peak ( r = 0.57, P < 0.001) and O 2 at AT ( r = 0.45, P < 0.001) while skeletal muscle mass was only weakly associated with O 2 peak ( r = 0.24, P < 0.010). In the multivariate analysis, only SM‐RA was associated with O 2 peak ( B = 0.25, 95% CI 0.15–0.34, P < 0.001, R 2 = 0.42) and O 2 at AT ( B = 0.13, 95% CI 0.06–0.18, P < 0.001, R 2 = 0.26). Conclusions There is a positive association between preoperative CT SM‐RA and preoperative physical fitness ( O 2 at AT and at peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Com...

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“…A recent systematic review [47**] from 37 studies including 7852 patients concluded CPET was a useful preoperative risk-stratification tool able to predict postoperative outcome in patients across a range of surgical specialties, but further research was needed to justify ability of CPET to predict postoperative outcome. Following this review, the first multi-center perioperative CPET study[48**] evaluated the relationship between CPET measurements and in-hospital morbidity in 703 patients undergoing major elective colorectal surgery in 6 centers. Consistent with previous studies, both anaerobic threshold and peak oxygen consumption (VO 2 P) were predictive of postoperative morbidity with area under the ROC curve (AUROC) of 0·79 and 0·77 respectively.…”

Section: Personalizing Prehabilitative and Post-icu Exercise Intervenmentioning

confidence: 99%

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise

Wischmeyer

Puthucheary

Millán

et al. 2017

Current Opinion in Critical Care

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Purpose of Review We have significantly improved hospital mortality from sepsis and critical illness in last 10 years, however over this same period we have tripled the number of “ICU survivors” going to rehabilitation. Further, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life (QoL). For those who do survive, recent data reveals many “ICU survivors” will suffer significant functional impairment or Post-ICU Syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anti-catabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care. Recent findings New data for novel LBM analysis technique such as CT scan and ultrasound analysis of lean body mass are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-breath testing is a novel technique under study to predict infection earlier and predict over- and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing (CPET) to target pre-operative exercise optimization and post-ICU recovery are becoming reality. Summary New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more “survivors” and fewer victim's post-ICU care.

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Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery

Abstract: These data provide further evidence that variables derived from preoperative CPET can be used to assess risk before elective colorectal surgery.

Cited by 123 publications

References 30 publications

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise

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