Skip to main content
Erschienen in: European Surgery 6/2015

01.12.2015 | Original Article

Cardiopulmonary exercise testing versus spirometry as predictors of cardiopulmonary complications after colorectal surgery

verfasst von: Mr. I. Nikolopoulos, MBBS, MSc, MRCS, Mrs. M. Ellwood, Mr. M. George, MBBS, BSc, MS, FRCS (Gen), Mr. E. Carapeti, MBBS, BSc, MD, FRCS (Gen), Mr. A. Williams, MBBS, BSc, MS, FRCS (Gen)

Erschienen in: European Surgery | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Summary

Background

To determine the predictive value of spirometry and cardiopulmonary exercise testing (CPET) preoperatively in patients scheduled to undergo elective colorectal surgery. We compared the preoperative results with the incidence of postoperative cardiopulmonary complications.

Methods

A total of 103 patients were scheduled to undergo preoperative CPET and spirometry; 14 patients did not attend their appointments and another 20 were unable to perform the test. In all, 69 patients (median age 60 years (range 25–85), 35 males) successfully completed cycle ergometry and lung function tests. Forced expiratory volume in 1 s (FEV1), percent forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC)) and anaerobic threshold (AT) were measured. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B).

Results

Postoperative cardiopulmonary complications developed in 8 of the 69 patients (12 %). Thirty day mortality was 3 %. AT was significantly higher in group A (mean AT = 13.8; SD ± 3.0; range = 8.1–20.8) than in group B (mean = 10.91; SD ± 3.0; Range = 7.9–12), (p = 0.0006). Spirometric pulmonary function tests (FEV1, p = 0.09) and (FEV1/FVC, p = 0.08) showed no intergroup differences. The median hospital length of stay (HLOS) was significantly higher in the group of patients that suffered cardiopulmonary complications (p = 0.0282).

Conclusions

CPET allows the prediction of postoperative cardiopulmonary complications which cannot be anticipated by spirometry. Early detection of high risk patients facilitates the planning of patient specific management strategies which are likely to improve outcome through invasive monitoring and optimisation of cardio-respiratory function.
Literatur
1.
Zurück zum Zitat Buck N, Devlin HB, Lunn JN. The report of a confidential enquiry into perioperative deaths. London: King’s Fund Publishing Office; 1987. Buck N, Devlin HB, Lunn JN. The report of a confidential enquiry into perioperative deaths. London: King’s Fund Publishing Office; 1987.
2.
Zurück zum Zitat Tikkanen J, Hovi-Viander M. Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975. Acta Anaesthiol Scand. 1995;39:262–7.CrossRef Tikkanen J, Hovi-Viander M. Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975. Acta Anaesthiol Scand. 1995;39:262–7.CrossRef
3.
Zurück zum Zitat Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ. 2003;327:1196–201.PubMedCentralCrossRefPubMed Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ. 2003;327:1196–201.PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Del Guerico LRM, Cohn JD. Monitoring operative risk in the elderly. JAMA. 1980;243:1350–55.CrossRef Del Guerico LRM, Cohn JD. Monitoring operative risk in the elderly. JAMA. 1980;243:1350–55.CrossRef
5.
Zurück zum Zitat Beattie WS. Evidence-based perioperative risk reduction. Can J Anesth 2005;52(6):R1–R11. Beattie WS. Evidence-based perioperative risk reduction. Can J Anesth 2005;52(6):R1–R11.
6.
Zurück zum Zitat Modernising care for patients undergoing major surgery. Improving patient outcomes and increasing clinical efficiency. A report by the Improving Surgical Outcomes Group. June 2005. Modernising care for patients undergoing major surgery. Improving patient outcomes and increasing clinical efficiency. A report by the Improving Surgical Outcomes Group. June 2005.
7.
Zurück zum Zitat Lawrence VA, Page CP, Harris GD. Preoperative spirometry before abdominal operations. Arch Intern Med. 1989;149:280–5.CrossRefPubMed Lawrence VA, Page CP, Harris GD. Preoperative spirometry before abdominal operations. Arch Intern Med. 1989;149:280–5.CrossRefPubMed
8.
Zurück zum Zitat Older P, Hall A, Hader R. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest. 1999;116:355–62.CrossRefPubMed Older P, Hall A, Hader R. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest. 1999;116:355–62.CrossRefPubMed
9.
Zurück zum Zitat West M, Jack S, Groccott MP. Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol. 2011;25:427–37.CrossRefPubMed West M, Jack S, Groccott MP. Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol. 2011;25:427–37.CrossRefPubMed
10.
Zurück zum Zitat Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009;64:883–93.CrossRefPubMed Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009;64:883–93.CrossRefPubMed
11.
Zurück zum Zitat Older P, Smith R. Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth Intensive Care. 1988;16:389–95.PubMed Older P, Smith R. Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth Intensive Care. 1988;16:389–95.PubMed
12.
Zurück zum Zitat Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest. 1992;102:208–15.CrossRefPubMed Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest. 1992;102:208–15.CrossRefPubMed
13.
Zurück zum Zitat Older P, Smith RER, Courtney PG, et al. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest. 1993;104:701–4.CrossRefPubMed Older P, Smith RER, Courtney PG, et al. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest. 1993;104:701–4.CrossRefPubMed
14.
Zurück zum Zitat West MA, Parry MG, Lythgoe D, Barben CP, Kemp GJ, Grocott MPW, Jack S. Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Brit J Surg. 2014;101(9):1166–72.CrossRefPubMed West MA, Parry MG, Lythgoe D, Barben CP, Kemp GJ, Grocott MPW, Jack S. Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Brit J Surg. 2014;101(9):1166–72.CrossRefPubMed
15.
Zurück zum Zitat Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel HW, Rosenberg J, Kehlet H. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Brit J Surg. 2002;89:446–53.CrossRefPubMed Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel HW, Rosenberg J, Kehlet H. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Brit J Surg. 2002;89:446–53.CrossRefPubMed
16.
Zurück zum Zitat Chassot PG, Delabays A, Spahn DR. Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. Br J Anaesth. 2002;89:747–59.CrossRefPubMed Chassot PG, Delabays A, Spahn DR. Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. Br J Anaesth. 2002;89:747–59.CrossRefPubMed
17.
Zurück zum Zitat Ashley EA, Myers J, Froelicher V. Exercise testing in clinical medicine. Lancet. 2000;356(9241):1592–7.CrossRefPubMed Ashley EA, Myers J, Froelicher V. Exercise testing in clinical medicine. Lancet. 2000;356(9241):1592–7.CrossRefPubMed
18.
Zurück zum Zitat Gauss A, Rohm HJ, Schaufelen A, et al. Electro-cardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery. Anesthesiology. 2001;94:38–46.CrossRefPubMed Gauss A, Rohm HJ, Schaufelen A, et al. Electro-cardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery. Anesthesiology. 2001;94:38–46.CrossRefPubMed
19.
Zurück zum Zitat Giangos R, Detrain R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta-analysis. Circulation. 1989;80:87–98.CrossRef Giangos R, Detrain R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta-analysis. Circulation. 1989;80:87–98.CrossRef
20.
Zurück zum Zitat Schlant RC, Friesinger GC, Leonard JJ, et al. Clinical competence in exercise testing: a statement for physicians from the ACP/ACC/AHA task force on clinical priviledges in cardiology. Circulation. 1990;82:1884–8.CrossRef Schlant RC, Friesinger GC, Leonard JJ, et al. Clinical competence in exercise testing: a statement for physicians from the ACP/ACC/AHA task force on clinical priviledges in cardiology. Circulation. 1990;82:1884–8.CrossRef
21.
Zurück zum Zitat Philbin EF, Ries MD, French TS. Feasibility of maximal cardiopulmonary exercise testing in patients with end-stage arthritis of the hip and knee prior to total joint arthroplasty. Chest. 1995;108:174.CrossRefPubMed Philbin EF, Ries MD, French TS. Feasibility of maximal cardiopulmonary exercise testing in patients with end-stage arthritis of the hip and knee prior to total joint arthroplasty. Chest. 1995;108:174.CrossRefPubMed
22.
Zurück zum Zitat Fletcher GF, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards: A statement for health professionals from the American Heart Association. Circulation;82:2286–322. Fletcher GF, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards: A statement for health professionals from the American Heart Association. Circulation;82:2286–322.
23.
Zurück zum Zitat American Thoracic Society/American College of Chest Physicians. ATS/ACCP Statement on Cardiopulmonary Exercise Testing 2002. American Thoracic Society/American College of Chest Physicians. ATS/ACCP Statement on Cardiopulmonary Exercise Testing 2002.
24.
Zurück zum Zitat Lawrence VA, Page CP, Homs GD. Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value. Arch Intern med. 1989;149(2):280–5.CrossRefPubMed Lawrence VA, Page CP, Homs GD. Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value. Arch Intern med. 1989;149(2):280–5.CrossRefPubMed
25.
Zurück zum Zitat De Nino LA, Lawrence VA, Averyt EC, Hilsenbeck SG, Dhanda R, Page CP. Preoperative spirometry and laparotomy: blowing away dollars. Chest. 1997;111(6):1536–41.CrossRefPubMed De Nino LA, Lawrence VA, Averyt EC, Hilsenbeck SG, Dhanda R, Page CP. Preoperative spirometry and laparotomy: blowing away dollars. Chest. 1997;111(6):1536–41.CrossRefPubMed
26.
Zurück zum Zitat Morice RC, Peters EJ, Ryan MB, Putnam JB, Ali MK, Rith JA. Exercise testing in the evaluation of patients at high risk for complications from lung resection. Chest. 1992;101:353–61.CrossRef Morice RC, Peters EJ, Ryan MB, Putnam JB, Ali MK, Rith JA. Exercise testing in the evaluation of patients at high risk for complications from lung resection. Chest. 1992;101:353–61.CrossRef
27.
Zurück zum Zitat Nagamatsu Y, Shima I, Hayashi A, Yamana H, Shirouzu K, Ishitake T. Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection. Surg Today. 2004;34:107–110.CrossRefPubMed Nagamatsu Y, Shima I, Hayashi A, Yamana H, Shirouzu K, Ishitake T. Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection. Surg Today. 2004;34:107–110.CrossRefPubMed
Metadaten
Titel
Cardiopulmonary exercise testing versus spirometry as predictors of cardiopulmonary complications after colorectal surgery
verfasst von
Mr. I. Nikolopoulos, MBBS, MSc, MRCS
Mrs. M. Ellwood
Mr. M. George, MBBS, BSc, MS, FRCS (Gen)
Mr. E. Carapeti, MBBS, BSc, MD, FRCS (Gen)
Mr. A. Williams, MBBS, BSc, MS, FRCS (Gen)
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 6/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0359-z

Weitere Artikel der Ausgabe 6/2015

European Surgery 6/2015 Zur Ausgabe