James M Prentis1, Michael I Trenell, Dave J Jones, Tim Lees, Mike Clarke, Chris P Snowden. 1. Department of Perioperative and Critical Care Medicine, the Freeman Hospital, and the Institute of Cellular Medicine, Biomedical Research Centre for Ageing and Age Related Diseases, Newcastle University, Newcastle upon Tyne, United Kingdom. james.prentis@nuth.nhs.uk
Abstract
BACKGROUND: Aortic aneurysm repair is a high-risk surgical procedure. Patients are often elderly, with multiple comorbidities that predispose them to perioperative morbidity. Use of endovascular aneurysm repair (EVAR) has increased due to reduced early perioperative risk. This study assessed whether preoperative cardiopulmonary exercise testing (CPET) could be used to predict morbidity and hospital length of stay (LOS) after aortic aneurysm repair. METHODS: A total of 185 patients underwent surgical repair (84 open repairs, 101 EVAR) and had adequate determination of a submaximal CPET parameter (anaerobic threshold). RESULTS: Patient comorbidities and cardiorespiratory fitness, derived from CPET, were similar between surgical procedures. Patients undergoing EVAR had fewer complications (10% vs 32%; P<.0001) and shorter mean (standard deviation [SD]) hospital LOS of 5.7 (9.3) days vs 14.4 (10.9) days compared with open repair (P<.0001). The hospital LOS was significantly increased in patients with one or more complications in both groups compared with those with no complications. In the open repair group, the level of fitness, as defined by anaerobic threshold, was an independent predictor of postoperative morbidity and hospital LOS. When the optimal anaerobic threshold (10 mL/min/kg) derived from receiver operator curve analysis was used as a cutoff value, unfit patients stayed significantly longer than fit patients in critical care (mean, 6.4 [SD, 6.9] days vs 2.4 [SD, 2.9] days; P=.002) and in the hospital (mean, 23.1 [SD, 14.8] days vs 11.0 [SD, 6.1] days; P<.0001). In contrast, fitness in the EVAR group was not predictive of postoperative morbidity but did have predictive value for hospital LOS. CONCLUSIONS: Cardiorespiratory fitness holds significant clinical value before aortic aneurysm repair in predicting postsurgical complications and duration of critical care and hospital LOS. Preoperative measurement of fitness could then direct clinical management with regard to operative choice, postoperative resource allocation, and informed patient decision making.
BACKGROUND: Aortic aneurysm repair is a high-risk surgical procedure. Patients are often elderly, with multiple comorbidities that predispose them to perioperative morbidity. Use of endovascular aneurysm repair (EVAR) has increased due to reduced early perioperative risk. This study assessed whether preoperative cardiopulmonary exercise testing (CPET) could be used to predict morbidity and hospital length of stay (LOS) after aortic aneurysm repair. METHODS: A total of 185 patients underwent surgical repair (84 open repairs, 101 EVAR) and had adequate determination of a submaximal CPET parameter (anaerobic threshold). RESULTS: Patient comorbidities and cardiorespiratory fitness, derived from CPET, were similar between surgical procedures. Patients undergoing EVAR had fewer complications (10% vs 32%; P<.0001) and shorter mean (standard deviation [SD]) hospital LOS of 5.7 (9.3) days vs 14.4 (10.9) days compared with open repair (P<.0001). The hospital LOS was significantly increased in patients with one or more complications in both groups compared with those with no complications. In the open repair group, the level of fitness, as defined by anaerobic threshold, was an independent predictor of postoperative morbidity and hospital LOS. When the optimal anaerobic threshold (10 mL/min/kg) derived from receiver operator curve analysis was used as a cutoff value, unfit patients stayed significantly longer than fit patients in critical care (mean, 6.4 [SD, 6.9] days vs 2.4 [SD, 2.9] days; P=.002) and in the hospital (mean, 23.1 [SD, 14.8] days vs 11.0 [SD, 6.1] days; P<.0001). In contrast, fitness in the EVAR group was not predictive of postoperative morbidity but did have predictive value for hospital LOS. CONCLUSIONS: Cardiorespiratory fitness holds significant clinical value before aortic aneurysm repair in predicting postsurgical complications and duration of critical care and hospital LOS. Preoperative measurement of fitness could then direct clinical management with regard to operative choice, postoperative resource allocation, and informed patient decision making.
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: J Nucl Cardiol Date: 2015-02 Impact factor: 5.952
Authors: Mauro Augusto Dos Santos; Marisa Silva Santos; Bernardo Rangel Tura; Renata Félix; Adriana Soares X Brito; Andrea De Lorenzo Journal: J Nucl Cardiol Date: 2016-05-26 Impact factor: 5.952
Authors: S Straw; M A Waduud; M Drozd; P Warman; M A Bailey; C J Hammond; Sed Abdel-Rahman; K K Witte; Dja Scott Journal: Ann R Coll Surg Engl Date: 2020-04-01 Impact factor: 1.891
Authors: Garry A Tew; Matthew Weston; Elke Kothmann; Alan M Batterham; Joanne Gray; Karen Kerr; Denis Martin; Shah Nawaz; David Yates; Gerard Danjoux Journal: BMJ Open Date: 2014-01-10 Impact factor: 2.692
Authors: Stephen J Goodyear; Heng Yow; Mahmud Saedon; Joanna Shakespeare; Christopher E Hill; Duncan Watson; Colette Marshall; Asif Mahmood; Daniel Higman; Christopher He Imray Journal: Perioper Med (Lond) Date: 2013-05-19