Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review

Moran, J.; Wilson, F.; Guinan, E.; McCormick, P.; Hussey, J.; Moriarty,

British Journal of Anaesthesia, February 2016, Vol. 116 Issue:
Number 2 p177-177, 1p;

Background. Cardiopulmonary exercise
testing (CPET) is used as a preoperative risk-stratification tool for
patients undergoing non-cardiopulmonary intra-abdominal surgery.
Previous studies indicate that CPET may be beneficial, but research is
needed to quantify CPET values protective against poor postoperative
outcome [mortality, morbidity, and length of stay (LOS)]. Methods. This
systematic review aimed to assess the ability of CPET to predict
postoperative outcome. The following databases were searched: PubMed,
EMBASE, PEDro, The Cochrane Library, Cinahl, and AMED. Thirty-seven
full-text articles were included. Data extraction included the
following: author, patient characteristics, setting, surgery type,
postoperative outcome measure, and CPET outcomes. Results. Surgeries
reviewed were hepatic transplant and resection (n</it>=7), abdominal
aortic aneurysm (AAA) repair (n</it>=5), colorectal (n</it>=6),
pancreatic (n</it>=4), renal transplant (n</it>=2), upper
gastrointestinal (n</it>=4), bariatric (n</it>=2), and general
intra-abdominal surgery (n</it>=12). Cardiopulmonary exercise
testing-derived cut-points, peak oxygen consumption (VO2pk), and
anaerobic threshold (AT) predicted the following postoperative
outcomes: 90 day–3 yr survival (AT 9–11 ml kg−1 min−1) and intensive
care unit admission (AT <9.9–11 ml kg−1 min−1) after hepatic transplant
and resection, 90 day survival after AAA repair
VO2pk 15 ml kg−1 min−1), LOS and morbidity after pancreatic surgery (AT <10–10.1 ml kg−1
min−1), and mortality and morbidity after intra-abdominal surgery (AT
10.9 and <10.1 ml kg−1 min−1, respectively).
Cardiopulmonary exercise testing is a useful preoperative
risk-stratification tool that can predict postoperative outcome.
Further research is needed to justify the ability of CPET to predict
postoperative outcome in renal transplant, colorectal, upper
gastrointestinal, and bariatric surgery.