Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection.
BACKGROUND
The objective of this investigation was to assess the association of peak oxygen consumption (Vo(2)) with postoperative outcome in a prospective cohort of patients undergoing major lung resection for the treatment of lung cancer.


METHODS
Preoperative symptom-limited cardiopulmonary exercise testing (CPET) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy. Peak Vo(2) was tested for possible association with postoperative cardiopulmonary complications and mortality. Logistic regression analysis, validated by a bootstrap analysis, was used to adjust for the effect of other perioperative factors. The role of peak Vo(2) in stratifying the surgical risk was further assessed in different groups of patients subdivided according to their cardiorespiratory status.


RESULTS
Logistic regression showed that peak Vo(2) was an independent and reliable predictor of pulmonary complications (p = 0.04). All six deaths occurred in patients with a peak Vo(2) of < 20 mL/kg/min (four deaths in patients with a peak Vo(2) of < 12 mL/kg/min). The mortality rate in this high-risk group was 10-fold higher (4 of 30 patients; 13%) compared to those with higher peak Vo(2) (p = 0.006). Compared to patients with a peak Vo(2) of > 20 mL/kg/min, those with a peak Vo(2) of < 12 mL/kg/min had 5-fold, 8-fold, 5-fold, and 13-fold higher rates, respectively, of total cardiopulmonary complications pulmonary complications, cardiac complications, and mortality.


CONCLUSIONS
The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care.
Brunelli
Alessandro
A
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy. Electronic address: alexit_2000@yahoo.com.
Belardinelli
Romualdo
R
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Refai
Majed
M
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Salati
Michele
M
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Socci
Laura
L
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Pompili
Cecilia
C
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Sabbatini
Armando
A
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
D000368:Aged; D000465:Algorithms; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011013:Pneumonectomy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D012372:ROC Curve; D012129:Respiratory Function Tests; D018570:Risk Assessment