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Cardiopulmonary exercise testing and risk-assessment for intra-abdominal surgery: a systematic review

Moran J, Wilson F, Guinan E.British Journal of Anaesthesia. 116:177–91, 2016.

Blog by Justin Nazareth, MBBS

Cardiopulmonary exercise testing (CPET) is the gold standard to objectively measure an individual’s functional capacity. A growing body of evidence supports the prognostic utility of preoperative CPET in guiding perioperative care, including risk prediction, resource allocation and prehabilitation strategies.

This body of evidence is summarized in a systematic review by Moran and colleagues who assessed the prognostic value of CPET in predicting postoperative outcomes following intra-abdominal surgery. In summary, they proposed utility of the following cut-point points for various CPET-derived variables in guiding the perioperative management of patients undergoing major abdominal surgery:

  • Hepatic resection or transplant or resection: AT <9 mL.kg-1.min-1 for 90-day survival; 11.5 mL.kg-1.min-1 for 3-year survival; and < 9.9 – 11 ml.kg-1.min-1 to guide critical care admission
  • AAA repair: peak VO2 cut-point of 15 mL.kg-1.min-1 for 90 day survival
  • Pancreatic surgery: AT cut-point of < 10.1 mL.kg-1.min-1 predicts higher LOS and morbidity
  • Undifferentiated intra-abdominal surgery: AT cut-point of 10.1 ml kg-1min-1 for morbidity and 10.9 mL.kg-1.min-1 for mortality. AT 10.1 – 12 ml kg min should be treated with caution.

Cited / Reference: Moran J, Wilson F, Guinan E. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. British Journal of Anaesthesia. 116:177–91, 2016.
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