title: Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery.
abstract: OBJECTIVE
  Cardiopulmonary exercise testing (CPET) may predict which patients are at risk for adverse outcomes after major abdominal surgery. The primary aim of this study was to determine whether CPET variables are predicative of morbidity.
  
  
  METHODS
  High-risk patients undergoing elective, one-stage, open hepatic resection were preoperatively assessed using CPET. Morbidity, as defined by the Postoperative Morbidity Survey (POMS), was assessed on postoperative day 3.
  
  
  RESULTS
  A total of 104 patients underwent preoperative CPET and were included in the analysis. Of these, 73 patients (70.2%) experienced postoperative morbidity. Oxygen consumption at anaerobic threshold (V˙O2 at AT, ml/kg/min) was the only CPET predictor of postoperative morbidity on multivariable analysis, with an area under the curve (AUC) of 0.66 [95% confidence interval (CI) 0.55-0.76]. In patients requiring a major hepatic resection (three or more segments), a V˙O2 at AT of <10.2 ml/kg/min gave an AUC of 0.79 (95% CI 0.68-0.86) with 83.9% sensitivity and 52.0% specificity, 80.6% positive predictive value and 62.5% negative predictive value.
  
  
  CONCLUSIONS
  The application of a cut-off value for V˙O2 at AT of <10.2 ml/kg/min in patients undergoing major hepatic resection may be useful for predicting which patients will experience morbidity.
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Kasivisvanathan
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Nima
authors.initials: N
authors.lastname: Abbassi-Ghadi
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Andrew D M
authors.initials: AD
authors.lastname: McLeod
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Oliver
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Rao Baikady
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Shaman
authors.initials: S
authors.lastname: Jhanji
authors.affiliation: Department of Anaesthesia, University College London Hospitals, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cone
authors.affiliation: Department of Anaesthesia and Critical Care, The Royal Marsden, London, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wigmore
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010101:Oxygen Consumption; D010809:Physical Fitness; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome