Introduction Cardiopulmonary Exercise Testing (CPET) is a non-invasive test that has been used to identify patients at higher perioperative risk. Studies have found that different CPET variables seem to be more predictive in different patient groups. There is little literature on the use of CPET within the HPB field, and no series concentrating on patients undergoing Liver resection. Our aim was to identify the most sensitive CPET variable for risk prediction in this patient group.
Methods From 1 October 2009 CPET was carried out in all patients due to undergo Liver resection meeting one or more of the following criteria (1) planned extended right/or extended left resection (2) over 65 (3) significant comorbidities. Data were prospectively entered into a database. This was correlated with preoperative CPET data and analysed using version 19 of SPSS.
Results Between 1 October 2009 and 1 July 2011 188 patients underwent Liver resection, 121 (64%) underwent CPET (Group A), and 67(36%) did not (Group B). Group A were older (mean age 70 vs 54) and had higher complication rates (56% vs 36%) and had longer length of stay (median 7 vs 5) (all p<0.001). The three deaths occurred within group A. Multivariate analysis of Group A including age, BMI, extent of surgery (segments), VO2 at anaerobic threshold (AT), VO2 peak, O2 pulse, and heart rate found that O2 pulse at AT, and HR at AT correlated best with a risk of increased complications. OR O2 pulse 0.86(CI 0.72 to 1.01, p 0.07), HR at AT 1.04 (CI 1.001 to 1.06, p<0.01).
Conclusion This is the largest study of CPET in the HPB field, and the only study involving only Liver resection. CPET can be used to identify those at higher perioperative risk, with O2 pulse and HR at the Anaerobic Threshold the most sensitive indicators. The selective use of CPET was justifiable as all patients who died in the postoperative period were identified. Complications still occurred within the non-CPET cohort suggesting expansion of CPET selection criteria may be needed.
Competing interests None declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.