Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery.

Publisher: published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society Country of Publication: United States NLM ID: 101607800 Publication Model: Print Cited Medium: Internet ISSN: 2051-817X (Electronic) Linking ISSN: 2051817X NLM ISO Abbreviation: Physiol Rep Subsets: MEDLINE

Original Publication: [Malden MA] : published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society, 2013-

Oxygen Consumption* ; Exercise Test*; Humans ; Retrospective Studies ; Pilot Projects ; Prognosis ; Risk Assessment ; Oxygen

This pilot study aimed to evaluate if peak VO 2 and ventilatory efficiency in combination would improve preoperative risk stratification beyond only relying on peak VO 2 . This was a single-center retrospective cohort study including all patients who underwent cardiopulmonary exercise testing (CPET) as part of preoperative risk evaluation before major upper abdominal surgery during years 2008-2021. The primary outcome was any major cardiopulmonary complication during hospitalization. Forty-nine patients had a preoperative CPET before decision to pursue to surgery (cancer in esophagus [n = 18], stomach [6], pancreas [16], or liver [9]). Twenty-five were selected for operation. Patients who suffered any major cardiopulmonary complication had lower ventilatory efficiency (i.e., higher VE/VCO 2 slope, 37.3 vs. 29.7, p = 0.031) compared to those without complications. In patients with a low aerobic capacity (i.e., peak VO 2  < 20 mL/kg/min) and a VE/VCO 2 slope ≥ 39, 80% developed a major cardiopulmonary complication. In this pilot study of patients with preoperative CPET before major upper abdominal surgery, patients who experienced a major cardiopulmonary complication had significantly lower ventilatory efficiency compared to those who did not. A low aerobic capacity in combination with low ventilatory efficiency was associated with a very high risk (80%) of having a major cardiopulmonary complication.
(© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

ARDS Definition Task Force, Ranieri, V. M., Rubenfeld, G. D., Thompson, B. T., Ferguson, N. D., Caldwell, E., Fan, E., Camporota, L., & Slutsky, A. S. (2012). Acute respiratory distress syndrome: The Berlin Definition. JAMA, 307(23), 2526-2533.
Ausania, F., Snowden, C. P., Prentis, J. M., Holmes, L. R., Jaques, B. C., White, S. A., French, J. J., Manas, D. M., & Charnley, R. M. (2012). Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy. The British Journal of Surgery, 99(9), 1290-1294.
Benington, S., Bryan, A., Milne, O., & Alkhaffaf, B. (2019). CPET and cardioesophagectomy: A single Centre 10-year experience. European Journal of Surgical Oncology, 45(12), 2451-2456.
Briez, N., Piessen, G., Torres, F., Lebuffe, G., Triboulet, J. P., & Mariette, C. (2012). Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Journal of British Surgery, 99(11), 1547-1553.
Brunelli, A., Belardinelli, R., Pompili, C., Xiume, F., Refai, M., Salati, M., & Sabbatini, A. (2012). Minute ventilation-to-carbon dioxide output (VE/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection. The Annals of Thoracic Surgery, 93(6), 1802-1806.
Brunelli, A., Kim, A. W., Berger, K. I., & Addrizzo-Harris, D. J. (2013). Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 143(5 Suppl), e166S-e190S.
Chua, T. P., Ponikowski, P., Harrington, D., Anker, S. D., Webb-Peploe, K., Clark, A. L., Poole-Wilson, P. A., & Coats, A. J. S. (1997). Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. Journal of the American College of Cardiology, 29(7), 1585-1590.
Corrà, U., Mezzani, A., Bosimini, E., Scapellato, F., Imparato, A., & Giannuzzi, P. (2002). Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. American Heart Journal, 143(3), 418-426.
Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205-213.
Fernandez, F. G., Falcoz, P. E., Kozower, B. D., Salati, M., Wright, C. D., & Brunelli, A. (2015). The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. The Annals of Thoracic Surgery, 99(1), 368-376.
Ghaferi, A. A., Birkmeyer, J. D., & Dimick, J. B. (2009). Variation in hospital mortality associated with inpatient surgery. The New England Journal of Medicine, 361(14), 1368-1375.
Gläser, S., Ittermann, T., Schäper, C., Obst, A., Dörr, M., Spielhagen, T., Felix, S. B., Völzke, H., Bollmann, T., Opitz, C. F., Warnke, C., Koch, B., & Ewert, R. (2013). The study of health in Pomerania (SHIP) reference values for cardiopulmonary exercise testing. Pneumologie, 67(1), 58-63.
Gläser, S., Koch, B., Ittermann, T., Schäper, C., Dörr, M., Felix, S. B., Völzke, H., Ewert, R., & Hansen, J. E. (2010). Influence of age, sex, body size, smoking, and beta blockade on key gas exchange exercise parameters in an adult population. European Journal of Cardiovascular Prevention and Rehabilitation, 17(4), 469-476.
Halvorsen, S., Mehilli, J., Cassese, S., Hall, T. S., Abdelhamid, M., Barbato, E., de Hert, S., de Laval, I., Geisler, T., Hinterbuchner, L., Ibanez, B., Lenarczyk, R., Mansmann, U. R., McGreavy, P., Mueller, C., Muneretto, C., Niessner, A., Potpara, T. S., Ristić, A., … Touyz, R. M. (2022). 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal, 43(39), 3826-3924.
Jack, S., West, M. A., Raw, D., Marwood, S., Ambler, G., Cope, T. M., Shrotri, M., Sturgess, R. P., Calverley, P. M. A., Ottensmeier, C. H., & Grocott, M. P. W. (2014). The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. European Journal of Surgical Oncology, 40(10), 1313-1320.
Junttila, A., Helminen, O., Mrena, J., & Sihvo, E. (2022). Exercise capacity in the stair-climbing test predicts outcomes of operable esophageal cancer in minimally invasive era. European Journal of Surgical Oncology, 48(3), 589-596.
Kristenson, K., Hylander, J., Boros, M., Fyrenius, A., & Hedman, K. (2022). Ventilatory efficiency in combination with peak oxygen uptake improves risk stratification in patients undergoing lobectomy. JTCVS Open, 11, 317-326.
Levett, D. Z. H., Jack, S., Swart, M., Carlisle, J., Wilson, J., Snowden, C., Riley, M., Danjoux, G., Ward, S. A., Older, P., Grocott, M. P. W., & Perioperative Exercise Testing and Training Society (POETTS). (2018). Perioperative cardiopulmonary exercise testing (CPET): Consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. British Journal of Anaesthesia, 120(3), 484-500.
Medinger, A. E., Khouri, S., & Rohatgi, P. K. (2001). Sarcoidosis: The value of exercise testing. Chest, 120(1), 93-101.
Mehani, S. H. M., & Abdeen, H. A. A. (2017). Cardiopulmonary rehabilitation program impact on prognostic markers in selected patients with resting and exercise-induced ventilatory inefficiency: A clinical trial. Journal of Physical Therapy Science, 29(10), 1803-1810.
Older, P. (2013). Anaerobic threshold, is it a magic number to determine fitness for surgery? Perioperative Medicine (Lond), 2(1), 2.
Pang, N. Q., Tan, Y. X., Samuel, M., Tan, K. K., Bonney, G. K., Yi, H., & Kow, W. C. A. (2022). Multimodal prehabilitation in older adults before major abdominal surgery: A systematic review and meta-analysis. Langenbeck's Archives of Surgery, 407(6), 2193-2204.
Sabaté, S., Mases, A., Guilera, N., Canet, J., Castillo, J., Orrego, C., Sabaté, A., Fita, G., Parramón, F., Paniagua, P., Rodríguez, A., & Sabaté, M. (2011). Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery. British Journal of Anaesthesia, 107(6), 879-890.
Roxburgh, B. H., Cotter, J. D., Campbell, H. A., Reymann, U., Wilson, L. C., Gwynne-Jones, D., van Rij, A. M., & Thomas, K. N. (2023). Physiological relationship between cardiorespiratory fitness and fitness for surgery: A narrative review. British Journal of Anaesthesia, 130(2), 122-132.
Salati, M., & Brunelli, A. (2016). Risk stratification in lung resection. Current Surgery Reports, 4(11), 37.
Shafiek, H., Valera, J. L., Togores, B., Torrecilla, J. A., Sauleda, J., & Cosio, B. G. (2016). Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: Beyond oxygen consumption. European Journal of Cardio-Thoracic Surgery, 50(4), 772-779.
Sivakumar, J., Forshaw, M. J., Lam, S., Peters, C. J., Allum, W. H., Whibley, J., Sinclair, R. C. F., Snowden, C. P., Hii, M. W., Sivakumar, H., & Read, M. (2022). Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data. Diseases of the Esophagus, 35(11), doac005. https://doi.org/10.1093/dote/doac005.
Snowden, C. P., Prentis, J. M., Anderson, H. L., Roberts, D. R., Randles, D., Renton, M., & Manas, D. M. (2010). Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Annals of Surgery, 251(3), 535-541.
Sun, X. G., Hansen, J. E., Garatachea, N., Storer, T. W., & Wasserman, K. (2002). Ventilatory efficiency during exercise in healthy subjects. American Journal of Respiratory and Critical Care Medicine, 166(11), 1443-1448.
Swart, M., Carlisle, J. B., & Goddard, J. (2017). Using predicted 30 day mortality to plan postoperative colorectal surgery care: A cohort study. British Journal of Anaesthesia, 118(1), 100-104.
Wasserman, K., Zhang, Y. Y., & Riley, M. S. (1996). Ventilation during exercise in chronic heart failure. Basic Research in Cardiology, 91(Suppl 1), 1-11.
Wijeysundera, D. N., Pearse, R. M., Shulman, M. A., Abbott, T. E. F., Torres, E., Ambosta, A., Croal, B. L., Granton, J. T., Thorpe, K. E., Grocott, M. P. W., Farrington, C., Myles, P. S., Cuthbertson, B. H., Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R. K., Douglas, J., … Wijeysundera, H. C. (2018). Assessment of functional capacity before major non-cardiac surgery: An international, prospective cohort study. Lancet, 391(10140), 2631-2640.
Wilson, R. J. T. (2018). Shades of grey: Embracing uncertainty in the exercise room. British Journal of Anaesthesia, 120(6), 1145-1146.
Wilson, R. J. T., Yates, D. R. A., Walkington, J. P., & Davies, S. J. (2019). Ventilatory inefficiency adversely affects outcomes and longer-term survival after planned colorectal cancer surgery. British Journal of Anaesthesia, 123(2), 238-245.
Zarate Rodriguez, J. G., Cos, H., Koenen, M., Cook, J., Lmsw, C. K., Raper, L., Guthrie, T., Strasberg, S. M., Hawkins, W. G., Hammill, C. W., Fields, R. C., Chapman, W. C., Eberlein, T. J., Kozower, B. D., & Sanford, D. E. (2023). Impact of Prehabilitation on postoperative mortality and the need for non-home discharge in high-risk surgical patients. Journal of the American College of Surgeons, 237, 558-567.

RÖ-965416 ALF Grants

Keywords: abdominal surgery; cardiopulmonary exercise testing; exercise capacity; functional capacity; ventilatory efficiency

S88TT14065 (Oxygen)

Date Created: 20240101 Date Completed: 20240103 Latest Revision: 20240117

20240117

PMC10758333

10.14814/phy2.15904

38163673