title: Cardiopulmonary Exercise Testing Has no Additive Incremental Value to Standard Scoring Systems when Risk Stratifying for Bariatric Surgery.
abstract: Cardiopulmonary exercise testing (CPET) can identify patients at risk of adverse post-operative outcomes following major abdominal surgery including bariatric surgery. Scoring systems that also aim to predict post-operative outcome in this group include the validated obesity surgery mortality risk score (OSMRS). This study aims to investigate if CPET has additive value to other scoring systems in predicting post-operative outcomes following bariatric surgery.
  
  
  
  Data was collected retrospectively on 398 patients who underwent CPET between October 2008 and April 2013. CPET data, medical history, complication rates and length of stay (LOS) were obtained from patient records. Data was analysed to investigate the relationship between CPET and other scoring systems with post-operative outcome.
  
  
  
  Two hundred and fifty patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Median LOS was 4 days (IQR 4-6 days) and 41 patients (16.4 %) developed a complication. Adjusted data showed a risk difference for complications of 17 % (95 % CI 9-25 %) between high- and low-risk patients stratified by OSMRS alongside a 27 % (95 % CI 12-45 %) longer LOS. Variation in AT or peak VO2showed no significant relationship with complications or LOS. Amongst high OSMRS risk patients, there was no significant difference in complications or LOS when CPET data was added to this analysis.
  
  
  
  Cardiopulmonary exercise testing adds no incremental value in predicting post-operative outcomes in the bariatric population compared to the OSMRS, which is strongly predictive of length of stay and complication following bariatric surgery.
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.
authors.forename: Samantha R
authors.initials: SR
authors.lastname: Warnakulasuriya
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Wilson
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Stone
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Redman
authors.affiliation: York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK. simon.davies@york.nhs.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012015:Reference Standards; D012107:Research Design / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Exercise test; Obesity; Post-operative complications; Risk assessment