TY - JOUR

T1 - Cardiorespiratory fitness fails to predict short-term postoperative mortality in patients undergoing elective open surgery for abdominal aortic aneurysm

AU - Bailey, D. M.

AU - Rose, G. A.

AU - Berg, R. M. G.

AU - Davies, R. G.

AU - Appadurai, I. R.

AU - Lewis, M. H.

AU - Williams, I. M.

PY - 2020/9

Y1 - 2020/9

N2 - INTRODUCTION Preoperative cardiopulmonary exercise testing aids surgical risk stratification and is an established predictor of mid- to long-term survival in patients undergoing elective open abdominal aortic aneurysm repair. Whether cardiopulmonary exercise testing also predicts 30-day mortality in this population remains to be established.MATERIALS AND METHODS Data for 109 patients (mean age 72 years) who underwent cardiopulmonary exercise testing to assess risk for surgical abdominal aortic aneurysm repair was analysed. Patients were classified according to cardiopulmonary fitness as fit (peak oxygen uptake >= 15ml O-2.kg(-l).min(-1)) or unfit (peak oxygen uptake less than 15ml O-2.kg(-l).min(-1)) and further stratified according to clamp position (infrarenal or suprarenal). Between-group postoperative outcomes were compared for in-hospital 30-day mortality, postoperative morbidity scale scores (day 5) and hospital length of stay.RESULTS Seventy-nine patients underwent open surgery and 30 patients were treated conservatively. No deaths were recorded at 30 days post-surgery. Unfit patients with infrarenal clamping exhibited higher postoperative morbidity scale scores (64% vs 26%) and longer length of stay (four days) than fit patients (p < 0.05). Conversely, with suprarenal clamping, postoperative morbidity scale scores were similar and length of stay longer (three days) in fit compared with unfit patients (p < 0.05).DISCUSSION AND CONCLUSION Preoperative fitness level defined by peak oxygen uptake failed to identify patients at risk of 30-day mortality when undergoing elective abdominal aortic aneurysm repair. Postoperative morbidity and length of stay in patients with suprarenal clamping was high independent of cardiopulmonary fitness. These findings suggest that cardiopulmonary exercise testing may be a useful predictor of complications following infrarenal rather than suprarenal clamping but may not be a good predictor of 30-day mortality.

AB - INTRODUCTION Preoperative cardiopulmonary exercise testing aids surgical risk stratification and is an established predictor of mid- to long-term survival in patients undergoing elective open abdominal aortic aneurysm repair. Whether cardiopulmonary exercise testing also predicts 30-day mortality in this population remains to be established.MATERIALS AND METHODS Data for 109 patients (mean age 72 years) who underwent cardiopulmonary exercise testing to assess risk for surgical abdominal aortic aneurysm repair was analysed. Patients were classified according to cardiopulmonary fitness as fit (peak oxygen uptake >= 15ml O-2.kg(-l).min(-1)) or unfit (peak oxygen uptake less than 15ml O-2.kg(-l).min(-1)) and further stratified according to clamp position (infrarenal or suprarenal). Between-group postoperative outcomes were compared for in-hospital 30-day mortality, postoperative morbidity scale scores (day 5) and hospital length of stay.RESULTS Seventy-nine patients underwent open surgery and 30 patients were treated conservatively. No deaths were recorded at 30 days post-surgery. Unfit patients with infrarenal clamping exhibited higher postoperative morbidity scale scores (64% vs 26%) and longer length of stay (four days) than fit patients (p < 0.05). Conversely, with suprarenal clamping, postoperative morbidity scale scores were similar and length of stay longer (three days) in fit compared with unfit patients (p < 0.05).DISCUSSION AND CONCLUSION Preoperative fitness level defined by peak oxygen uptake failed to identify patients at risk of 30-day mortality when undergoing elective abdominal aortic aneurysm repair. Postoperative morbidity and length of stay in patients with suprarenal clamping was high independent of cardiopulmonary fitness. These findings suggest that cardiopulmonary exercise testing may be a useful predictor of complications following infrarenal rather than suprarenal clamping but may not be a good predictor of 30-day mortality.

KW - Cardiopulmonary fitness

KW - Abdominal aortic aneurysm repair

KW - Mortality

KW - Morbidity

KW - Prediction

KW - EXERCISE

KW - SURVIVAL

KW - REPAIR

KW - RISK

U2 - 10.1308/rcsann.2020.0120

DO - 10.1308/rcsann.2020.0120

M3 - Journal article

C2 - 32538122

VL - 102

SP - 536

EP - 539

JO - Annals of the Royal College of Surgeons of England

JF - Annals of the Royal College of Surgeons of England

SN - 0035-8843

IS - 7

ER -