title: Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review.
abstract: BACKGROUND
  Cardiopulmonary exercise testing (CPET) is used as a preoperative risk-stratification tool for patients undergoing non-cardiopulmonary intra-abdominal surgery. Previous studies indicate that CPET may be beneficial, but research is needed to quantify CPET values protective against poor postoperative outcome [mortality, morbidity, and length of stay (LOS)].
  
  
  METHODS
  This systematic review aimed to assess the ability of CPET to predict postoperative outcome. The following databases were searched: PubMed, EMBASE, PEDro, The Cochrane Library, Cinahl, and AMED. Thirty-seven full-text articles were included. Data extraction included the following: author, patient characteristics, setting, surgery type, postoperative outcome measure, and CPET outcomes.
  
  
  RESULTS
  Surgeries reviewed were hepatic transplant and resection (n=7), abdominal aortic aneurysm (AAA) repair (n=5), colorectal (n=6), pancreatic (n=4), renal transplant (n=2), upper gastrointestinal (n=4), bariatric (n=2), and general intra-abdominal surgery (n=12). Cardiopulmonary exercise testing-derived cut-points, peak oxygen consumption ([Formula: see text]), and anaerobic threshold (AT) predicted the following postoperative outcomes: 90 day-3 yr survival (AT 9-11 ml kg(-1) min(-1)) and intensive care unit admission (AT <9.9-11 ml kg(-1) min(-1)) after hepatic transplant and resection, 90 day survival after AAA repair ([Formula: see text] 15 ml kg(-1) min(-1)), LOS and morbidity after pancreatic surgery (AT <10-10.1 ml kg(-1) min(-1)), and mortality and morbidity after intra-abdominal surgery (AT 10.9 and <10.1 ml kg(-1) min(-1), respectively).
  
  
  CONCLUSIONS
  Cardiopulmonary exercise testing is a useful preoperative risk-stratification tool that can predict postoperative outcome. Further research is needed to justify the ability of CPET to predict postoperative outcome in renal transplant, colorectal, upper gastrointestinal, and bariatric surgery.
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland moranj2@tcd.ie.
authors.forename: J
authors.initials: J
authors.lastname: Moran
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Wilson
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Guinan
authors.affiliation: Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: McCormick
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Hussey
authors.affiliation: Department of Anaesthesia and Intensive Care, St James's Hospital, Dublin, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Moriarty
mesh_terms: D000005:Abdomen / Q000601:surgery*; D005080:Exercise Test / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000175:diagnosis*; D011300:Preoperative Care / Q000706:statistics & numerical data*; D012372:ROC Curve; D018570:Risk Assessment
keywords: exercise test/methods; general surgery; health status indicators; postoperative complications; preoperative care/methods; preoperative period; prognosis; risk; risk assessment/methods