title: Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection.
abstract: 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.
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy. Electronic address: alexit_2000@yahoo.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Belardinelli
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Majed
authors.initials: M
authors.lastname: Refai
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Socci
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.affiliation: Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
mesh_terms: 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