Introduction Liver resection is a major operation with significant morbidity and mortality, and accurate pre-operative assessment of risk is important. Cardiopulmonary exercise testing (CPX) is used increasingly before major abdominal surgery, although its usefulness prior to hepatectomy is unclear. We wished to evaluate the role of CPX testing prior to liver resection.
Method Prospectively collected data were extracted from the HPB unit database. The study group excluded patients with chronic liver disease and biliary obstruction. CPX testing was introduced in February 2008, initially selectively but after November 2013 was used in all patients undergoing liver resection. Standard CPX and operative parameters were retrieved. Operative complications were classified according to the Clavien-Dindo system and grade 3–5 complications considered significant. Multi-variate methods were used to assess potential associations between pre-operative CPX parameters and operative complications.
Results Pre-operative CPX was performed on 183 occasions. Grade 3, 4 and 5 complications were suffered by 17, 38 and 3% of patients, respectively. A weak association was noted between increasing ventilatory equivalents for CO2(VE/CO2), the risk of Grade 3–5 complications (Odds ratio = 1.11, p = 0.015) and length of post-operative stay (p = 0.004). No association was noted between any other CPX variable and operative outcome.
Conclusion With the exception of VE/CO2,CPX test parameters did not predict the development of post-operative complications. It is likely that the majority of complications suffered after liver resection relate to technical aspects of the operation and are not associated with cardio-respiratory function.
Disclosure of interest None Declared.
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