Cardiopulmonary exercise testing, prehabilitation, and Enhanced
Recovery After Surgery (ERAS)
Levett, Denny; Grocott, Michael.
Canadian Journal of Anesthesia, February 2015, Vol. 62 Issue: Number 2
Abstract: This review evaluates the current and future
role of cardiopulmonary exercise testing (CPET) in the context of
Enhanced Recovery After Surgery (ERAS) programs.
There is substantial literature confirming the relationship between
physical fitness and perioperative outcome in general. The few small
studies in patients undergoing surgery within an ERAS program describe
less fit individuals having a greater incidence of morbidity and
mortality. There is evidence of increasing adoption of perioperative
CPET, particularly in the UK. Although CPET-derived variables have been
used to guide clinical decisions about choice of surgical procedure and
level of perioperative care as well as to screen for uncommon
comorbidities, the ability of CPET-derived variables to guide therapy
and thereby improve outcome remains uncertain. Recent studies have
reported a reduction in CPET-defined physical fitness following
neoadjuvant therapies (chemo- and radio-therapy) prior to surgery.
Preliminary data suggest that this effect may be associated with an
adverse effect on clinical outcomes in less fit patients. Early reports
suggest that CPET-derived variables can be used to guide the
prescription of exercise training interventions and thereby improve
physical fitness in patients prior to surgery (i.e., prehabilitation).
The impact of such interventions on clinical outcomes remains
uncertain. Perioperative CPET is finding an
increasing spectrum of roles, including risk evaluation, collaborative
decision-making, personalized care, monitoring interventions, and
guiding prescription of prehabilitation. These indications are
potentially of importance to patients having surgery within an ERAS
program, but there are currently few publications specific to CPET in
the context of ERAS programs.