Driessens H; University of Groningen, Groningen, the Netherlands.
Hoeijmakers LSM; Zwerver ODJ; Wijma AG; Hildebrand ND;
Queisen RRYC; Kuikhoven M; den Dulk M; Olde Damink SWM; Klaase JM; Bongers BC

BACKGROUND: The widespread implementation of a preoperative assessment of
aerobic capacity requires a practical field test. This study investigated
the validity of the modified steep ramp test (SRT) for evaluating
preoperative aerobic capacity and to evaluate its usefulness for
preoperative risk assessment in patients planned for pancreatic surgery.

METHODS: Patients scheduled for pancreatic surgery who preoperatively
performed cardiopulmonary exercise testing (CPET) and the modified SRT
within 14 days were included. To assess its criterion validity, the
correlation between the achieved work rate at peak exercise (WRpeak) at
the modified SRT and oxygen uptake (VO2) at peak exercise (VO2peak) during
CPET was determined. To evaluate the ability of the modified SRT to
correctly classify patients as fit or unfit, receiver operating
characteristic (ROC) analyses were performed based on the CPET VO2peak
cutoff 18.0 ml.kg-1.min-1 and VO2 at the ventilatory anaerobic threshold
(VAT) cutoff 11.0 ml.kg-1.min-1.

RESULTS: Forty-eight patients (21 females) aged 68.7 +/- 7.6 years were
included. Modified SRT WRpeak (W/kg) demonstrated a very strong
correlation with CPET VO2peak (rho = 0.865, r = 0.926). The modified SRT
WRpeak cutoff to most accurately classify patients as fit or unfit was
2.095 W/kg for the CPET VO2peak cutoff (area under the curve (AUC) of
0.948) and the CPET VO2 at the VAT cutoff (AUC of 0.814).

CONCLUSIONS: The modified SRT is a valid short-term practical exercise
test to preoperatively assess aerobic capacity in patients undergoing
pancreatic surgery. A modified SRT performance below 2.1 W/kg seems
clinically most suitable to select candidates for further preoperative
CPET evaluation and/or prehabilitation, given its positive and negative
predictive value.