The Role of Cardiopulmonary Exercise Testing as a Risk Assessment Tool in Patients Undergoing Oesophagectomy: A Systemat
- PDF / 653,879 Bytes
- 14 Pages / 595.276 x 790.866 pts Page_size
- 47 Downloads / 175 Views
REVIEW ARTICLE – THORACIC ONCOLOGY
The Role of Cardiopulmonary Exercise Testing as a Risk Assessment Tool in Patients Undergoing Oesophagectomy: A Systematic Review and Meta-analysis Jonathan Sivakumar, MBBS, PGDipSurgAnat, MS1,2 , Harry Sivakumar, MBBS, BMedSci (Hons)3, Matthew Read, MBBS, FRACS1, Rhona C. F. Sinclair, BMedSci, BMBS, MPhil, MRCP, FRCA4, Chistopher P. Snowden, MBBS, FRCA, MD5, and Michael W. Hii, MBBS, BMedSci, PGDipSurgAnat, FRACS1,2 1
Department of Upper Gastrointestinal Surgery, St Vincent’s Hospital Melbourne, Melbourne, Australia; 2Department of Surgery, The University of Melbourne, Melbourne, Australia; 3Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia; 4Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; 5Department of Anaesthesia, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
ABSTRACT Introduction. Cardiopulmonary exercise testing (CPET) is an objective method of assessing functional capacity to meet the metabolic demands of surgery and has been adopted as a preoperative risk-stratification tool for patients undergoing major procedures. The two main measures are _ 2peak) the peak rate of oxygen uptake during exercise (VO and anaerobic threshold (AT), the point at which anaerobic metabolism exceeds aerobic metabolism during exercise. This systematic review and meta-analysis evaluates the predictive value of CPET for patients undergoing oesophagectomy. Methods. A systematic literature search was conducted in databases of CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Scopus to identify studies that examined associations between preoperative CPET variables and postoperative outcomes following oesophagectomy. Results were presented as standardised mean difference (SMD) with 95% confidence interval.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08638-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 5 February 2020 J. Sivakumar, MBBS, PGDipSurgAnat, MS e-mail: [email protected]
Results. Seven studies were included in this review. Pre_ 2peak operative VO moderately correlated with cardiopulmonary complications [SMD = - 0.43; 95% confidence interval (CI) - 0.77 to - 0.09; p = 0.013; I2 = 80.4%], unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.60 to - 0.08; p = 0.011; I2 = 0.0%), and 1year survival (SMD = 0.31; 95% CI 0.02–0.61; p = 0.045; I2 = 0.0%). Preoperative AT values moderately correlated with unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.61 to - 0.07; p = 0.014; I2 = 0.0%), and 1-year survival (SMD = 0.34; 95% CI 0.00–0.68; p = 0.049; _ 2peak nor AT demonstrated progI2 = 7.4%). Neither VO nostic value for noncardiopulmonary complications. _ 2peak and AT, where measured by preConclusions. VO operative CPET testing, are inversely associated with postoperative cardiopulmonary complica
Data Loading...
