title: Cardiopulmonary exercise testing before liver surgery.
abstract: BACKGROUND
  Cardiopulmonary exercise testing (CPET) assessed "poorer" fitness correlates with poorer outcomes in blinded studies. Whether this correlation will persist when CPET is utilized to stratify care as part of a multi-modal enhanced recovery after surgery (ERAS) program is unclear. This study examined whether CPET variables were associated with postoperative morbidity in patients undergoing hepatectomy within an ERAS program.
  
  
  OBJECTIVE
  Data were prospectively collected on patients undergoing elective hepatectomy between October 2009 and April 2011. The relationships between CPET derived variables; postoperative complications and length of stay were investigated.
  
  
  RESULTS
  Of 267 patients undergoing surgery, 197 had undergone standard cycle ergometer CPET. The relative oxygen uptake [VO2 (ml kg(-1) min(-1))] and ventilatory equivalent of CO2 (VE/VCO2) at the anaerobic threshold (AT) were not associated with complications or length of stay. Greater absolute oxygen uptake at AT [VO2 at AT (L min(-1) )] was associated with early hospital discharge [OR 2.16 (95% CI 1.18-3.96), P = 0.013] on multivariable analysis.
  
  
  CONCLUSIONS
  When CPET is used to delineate perioperative management a low relative oxygen uptake [VO2 (ml kg(-1) min(-1) )] at the AT does not place patients at significantly higher risk of postoperative complications. This suggests CPET assessed "poor" fitness should not be used as a barrier to surgical intervention.
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Declan F J
authors.initials: DF
authors.lastname: Dunne
authors.forename: Robert P
authors.initials: RP
authors.lastname: Jones
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lythgoe
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Pilkington
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Palmer
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Carmen
authors.initials: C
authors.lastname: Lacasia
authors.forename: Sandy
authors.initials: S
authors.lastname: Jack
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Fenwick
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
keywords: ERAS; cardiopulmonary exercise testing; exercise testing; hepatectomy; preopertive assessment