The role of cardiopulmonary fitness and its genetic influences on surgical outcomes.
BACKGROUND
Outcome after major surgery remains poor in some patients. There is an increasing need to identify this cohort and develop strategies to reduce postsurgical morbidity and mortality. Central to outcome is the ability to mount cardiovascular output in response to the increased oxygen demand associated with major surgery.


METHODS
A medline search was performed using keywords to identify factors that affect, and genetic influences in, disease and outcome from surgery, and all relevant English language articles published between 1980 and 2005 were retrieved. Secondary references were obtained from key articles.


RESULTS
Preoperative cardiopulmonary exercise testing assesses patient fitness, highlights those at particular risk and, combined with triage to critical care, facilitates significant improvement in surgical outcome. However, genetic factors also influence responses to increased oxygen demand, and some patients are genetically predisposed to mounting increased inflammatory responses, which raise oxygen demand further. Polymorphisms in genes influencing fitness (angiotensin converting enzyme) and immune and inflammatory responses (such as interleukin 6) may associate with surgical outcome.


CONCLUSIONS
Development of preoperative screening methods like cardiopulmonary exercise testing and genotype analysis to identify index factors may permit better patient stratification, provide targets for future tailored treatments and so improve surgical outcome.
Lee
J T
JT
Department of Surgery, The Royal Free and University College Medical School, The Middlesex Hospital, Mortimer Street, London W1T 3AA, UK.
Chaloner
E J
EJ
Hollingsworth
S J
SJ
D000806:Angiotensin-Converting Enzyme Inhibitors; D017544:Aortic Aneurysm, Abdominal / Q000235:genetics / Q000601:surgery; D002320:Cardiovascular Physiological Phenomena; D001026:Coronary Artery Bypass / Q000379:methods; D005080:Exercise Test; D005823:Genetics; D006801:Humans; D016377:Organ Transplantation / Q000379:methods; D010101:Oxygen Consumption; D010809:Physical Fitness / Q000502:physiology*; D011183:Postoperative Complications; D044469:Racial Groups; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D018805:Sepsis / Q000235:genetics; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors