Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: A systematic review.

Argillander TE; Heil TC; Melis RJF; van Duijvendijk P; Klaase JM;
van Munster BC

BACKGROUND: Abdominal cancer surgery is associated with considerable
morbidity in older patients. Assessment of preoperative physical status is
therefore essential. The aim of this review was to describe and compare
the objective physical tests that are currently used in abdominal cancer
surgery in the older patient population with regard to postoperative

METHODS: Medline, Embase, CINAHL and Web of Science were searched until
31 December 2020. Non-interventional cohort studies were eligible if they
included patients >=65 years undergoing abdominal cancer surgery, reported
results on objective preoperative physical assessment such as
Cardiopulmonary Exercise Testing (CPET), field walk tests or muscle
strength, and on postoperative outcomes.

RESULTS: 23 publications were included (10 CPET, 13 non-CPET including
Timed Up & Go, grip strength, 6-minute walking test (6MWT) and incremental
shuttle walk test (ISWT)). Meta-analysis was precluded due to
heterogeneity between study cohorts, different cut-off points, and
inconsistent reporting of outcomes. In CPET studies, ventilatory anaerobic
threshold and minute ventilation/carbon dioxide production gradient were
associated with adverse outcomes. ISWT and 6MWT predicted outcomes in two
studies. Tests addressing muscle strength and function were of limited
value. No study compared different physical tests.

DISCUSSION: CPET has the ability to predict adverse postoperative
outcomes, but it is time-consuming and requires expert assessment. ISWT or
6MWT might be a feasible alternative to estimate aerobic capacity. Muscle
strength and function tests currently have limited value in risk
prediction. Future research should compare the predictive value of
different physical instruments with regard to postoperative outcomes in
older surgical patients.