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

Kristenson K; Linkoping University, Linkoping, Sweden
Gerring E; Bjornsson B; Sandstrom P; Hedman K

Physiological Reports. 12(1):e15904, 2024 Jan.

This pilot study aimed to evaluate if peak VO2 and ventilatory efficiency
in combination would improve preoperative risk stratification beyond only
relying on peak VO2 . 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/VCO2 slope, 37.3 vs. 29.7, p = 0.031) compared to those without
complications. In patients with a low aerobic capacity (i.e., peak VO2 <
20 mL/kg/min) and a VE/VCO2 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